title: Increased levator muscle function by supramaximal resection in patients with blepharophimosis-ptosis-epicanthus inversus syndrome.
abstract: OBJECTIVE
  To study the efficacy and clinical and anatomical results of supramaximal levator resection in patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) with severe congenital ptosis with poor levator function (LF).
  
  
  METHODS
  Eleven patients with molecularly proven BPES underwent supramaximal levator resection. Palpebral fissure height and LF were measured preoperatively and postoperatively.
  
  
  RESULTS
  All patients showed an excellent reduction in ptosis with a single intervention resulting in a clear visual axis. Palpebral fissure height improved from mean (SD) 3.3 (0.7) mm preoperatively to 7.1 (0.9) mm postoperatively (P value <.001). Four patients underwent additional surgery because of cosmetic issues with eyelid height asymmetry. All patients showed a marked, consistent, and lasting improvement in LF, going from mean (SD) 1.9 (0.9) mm preoperatively to 7.4 (1.1) mm postoperatively (P value <.001). This improvement could be attributed to the presence of a very long and thin tendon, as well as a striated muscle belly. This elongated aponeurosis inhibits the levator muscle from having sufficient impact on the vertical eyelid excursion.
  
  
  CONCLUSIONS
  We demonstrated that supramaximal levator resection performed in patients with BPES not only results in good cosmetic appearance in terms of ptosis reduction in the majority of cases but also in a significant increase of the levator palpebrae superioris function. An anatomical substrate was found to explain these findings. To our knowledge, this is the first study to provide evidence of a marked increase in LF in BPES due to resection of the elongated tendon with reinsertion of the muscle belly.
authors.affiliation: Department of Ophthalmology, Ghent University Hospital, Belgium. christian.decock@ugent.be
authors.forename: Christian E
authors.initials: CE
authors.lastname: Decock
authors.forename: Akash D
authors.initials: AD
authors.lastname: Shah
authors.forename: Christophe
authors.initials: C
authors.lastname: Delaey
authors.forename: Ramses
authors.initials: R
authors.lastname: Forsyth
authors.forename: Wouter
authors.initials: W
authors.lastname: Bauters
authors.forename: Philippe
authors.initials: P
authors.lastname: Kestelyn
authors.forename: Elfride
authors.initials: E
authors.lastname: De Baere
authors.forename: Ilse
authors.initials: I
authors.lastname: Claerhout
mesh_terms: D000293:Adolescent; D016569:Blepharophimosis / Q000503:physiopathology / Q000601:surgery*; D001763:Blepharoptosis / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005143:Eyelids / Q000002:abnormalities* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009801:Oculomotor Muscles / Q000503:physiopathology* / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D013577:Syndrome; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome