title: Direct tarsus to frontalis muscle sling without flap creation for correction of blepharoptosis with poor levator function.
abstract: OBJECTIVE
  To report the outcomes of ptosis surgery in patients with weak levator function utilizing the direct tarsus to frontalis muscle sling technique without creation of a flap.
  
  
  METHODS
  In a prospective nonrandomized case series over a 3-year period, patients with ptosis and weak (less than 4 mm) levator function underwent direct sling of the tarsus to frontalis muscle without creating any flap. Success was defined as upper lid margin to central corneal reflex distance of at least 3 mm in bilateral cases and a difference of less than 1 mm in unilateral cases.
  
  
  RESULTS
  Overall, 26 eyes of 22 patients with mean age of 15.4 ± 9.4 years were operated and followed up for 13.5 ± 8.4 months. The ptosis was congenital in 15 patients (68.2%) and acquired in 7 patients (31.8%). Twelve patients (54.5%) had a history of ptosis surgery. The procedure was judged as successful in 77.3% of patients after initial surgery and in 100% after reoperation. Surgical success after initial surgery was directly correlated with the amount of levator function (P = 0.02). However, success was not associated with age (P = 0.9) or history of surgery (P = 0.9). None of the patients developed eyelid hematoma, lagophthalmus or dry eye.
  
  
  CONCLUSIONS
  Direct sling of the upper tarsus to the frontalis muscle without creation of flap is an effective procedure for correction of ptosis in patients with weak levator function. Minimal dissection and preservation of the orbicularis oculi prevents lagophthalmus and its consequences.
authors: Department of Ophthalmology, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. abbasbagheri@yahoo.com
authors: Abbas
authors: A
authors: Bagheri
authors: Hashem
authors: H
authors: Ahadi
authors: Babak
authors: B
authors: Babsharif
authors: Hossein
authors: H
authors: Salour
authors: Shahin
authors: S
authors: Yazdani
mesh_terms: D000293:Adolescent; D000328:Adult; D001763:Blepharoptosis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D013524:Surgical Flaps; D055815:Young Adult