title: Transcaruncular medial canthal ligament plication for repair of lower eyelid malposition.
abstract: OBJECTIVE
  To evaluate the long-term efficacy of transcaruncular medial canthal ligament (MCL) plication in the treatment of eyelid malposition.
  
  
  METHODS
  Transcaruncular MCL plication was performed on 176 eyelids of 125 patients with symptomatic ocular exposure due to lower eyelid malposition in which MCL laxity was an important component. Preoperative and postoperative ocular exposure symptoms, lower eyelid position, lagophthalmos, and keratopathy were compared.
  
  
  RESULTS
  At an average +/- SD follow-up time of 25 +/- 27 months (range, 1-103 months), 88% of preoperative symptoms resolved or improved. Lower eyelid position (P<.001), lagophthalmos (P<.001), and keratopathy (P<.001) were significantly improved. In 11% of eyelids undergoing MCL plication as the only repair, results were comparable with those in which other repairs were performed concurrently. Complications were suture breakage in 2 cases and pyogenic granuloma in 1 case.
  
  
  CONCLUSIONS
  Transcaruncular MCL plication is a safe and effective technique for MCL laxity that contributes to lower eyelid malposition. This minimally invasive technique achieves good functional and cosmetic outcomes by re-establishing the vectoral forces for eyelid support that are normally provided by the tripartite ligament.
authors.affiliation: University of Michigan, Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105, USA. velner@umich.edu
authors.forename: Victor M
authors.initials: VM
authors.lastname: Elner
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirci
authors.forename: Asa D
authors.initials: AD
authors.lastname: Morton
authors.forename: Susan G
authors.initials: SG
authors.lastname: Elner
authors.forename: Adam S
authors.initials: AS
authors.lastname: Hassan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005141:Eyelid Diseases / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies