title: Long-term outcomes of surgical approaches to the treatment of floppy eyelid syndrome.
abstract: OBJECTIVE
  To identify and describe the different procedures used in the treatment of floppy eyelid syndrome (FES) at Moorfields Eye Hospital and to evaluate their effectiveness.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A total of 71 patients who had undergone surgery for FES over a 13-year period since 1995 at Moorfields Eye Hospital were recruited. Retrospective data from 7 patients were also included, providing data for 78 patients.
  
  
  METHODS
  Patients underwent a full ocular examination. A survival analysis was determined by plotting Kaplan-Meier curves for each type of procedure encountered. Comparison of survival trends was made using a log-rank test. The possible effects of bias arising from bilaterality of the condition were investigated using a sensitivity analysis and a Cox regression analysis allowing for clusters. Tests for surgeon bias were made using the Fisher exact test.
  
  
  METHODS
  Recurrence of the condition. An assessment of recurrence was made clinically by 2 independent observers who were masked to the type of surgery the patient had undergone.
  
  
  RESULTS
  Four different forms of surgical treatment were encountered: (1) Full-thickness wedge excision (FTWE) (26 patients, 33 procedures); (2) Upper lid lateral tarsal strip (LTS) (31 patients, 43 procedures); (3) Medial canthal (MC) and lateral canthal (LC) plication (15 patients, 19 procedures); (4) Medial tarsal strip (6 patients, 6 procedures). A total of 44 of 101 procedures had failed. Superior long-term survival outcomes of both LC/MC plication (P = 0.003) and upper lid LTS (P = 0.001) procedures over FTWE was demonstrated. However, survival comparison between the LC/MC plication and LTS groups did not achieve significance (P = 0.37). No significant difference in outcome between surgeon groups of equivalent experience was demonstrated (P = 0.18). No bias arising from bilaterality of the condition was identified.
  
  
  CONCLUSIONS
  These data provide strong evidence of better survival outcomes in FES using the MC/LC plication and LTS procedures in comparison with the FTWE procedure. On the basis of experience from our unit, we recommend that the FTWE procedure be avoided as a form of treatment for FES in favor of the MC/LC plication, LTS, or medial tarsal strip procedure.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: National Institute for Health Research, Biomedical Research Centre for Ophthalmology, 2nd Floor Richard Desmond Childrens Eye Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, NHS Foundation Trust, London, United Kingdom. d.ezra@ucl.ac.uk
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Ezra
authors.forename: Michèle
authors.initials: M
authors.lastname: Beaconsfield
authors.forename: Mano
authors.initials: M
authors.lastname: Sira
authors.forename: Catey
authors.initials: C
authors.lastname: Bunce
authors.forename: Sabrina
authors.initials: S
authors.lastname: Shah-Desai
authors.forename: David H
authors.initials: DH
authors.lastname: Verity
authors.forename: Jimmy
authors.initials: J
authors.lastname: Uddin
authors.forename: Richard
authors.initials: R
authors.lastname: Collin
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D003430:Cross-Sectional Studies; D005141:Eyelid Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome