title: Factors affecting eyelid crease formation before and after silicone frontalis suspension for adult-onset myogenic ptosis.
abstract: OBJECTIVE
  To evaluate factors that affect eyelid crease formation before and after frontalis suspension.
  
  
  METHODS
  Nonrandomized, comparative, interventional case series.
  
  
  METHODS
  Sixty-three patients (125 eyes) with myogenic ptosis were included. Data collected included age, gender, previous surgeries, follow up, as well as pre- and postoperative margin reflex distance, palpebral fissure height, and levator function. Intraoperative maneuvers of incorporation of the levator aponeurosis into the skin closure, conservative fat excision, and conservative skin excision were recorded. Pre- and postoperative eyelid creases were graded by 2 masked, independent observers as "good," "fair," or "poor."
  
  
  RESULTS
  The weighted κ coefficient between the graders was 0.68 (95% CI, 0.58-0.79) preoperatively and 0.70 (95% CI, 0.61-0.79) postoperatively. Evaluating preoperative eyelid crease grades, there was no significant difference with regard to age or gender (p = 0.83 or 0.69, respectively). Eyelid crease grade correlated with margin reflex distance (p = 0.0004) and palpebral fissure height (p = 0.002). There was no significant correlation of eyelid crease with levator function (p = 0.104). After frontalis sling, intraoperative maneuvers of incorporation of the levator aponeurosis into the incision, skin preservation, and fat preservation correlated with postoperative eyelid crease (p = 0.0004, 0.059, and 0.033, respectively).
  
  
  CONCLUSIONS
  Preoperative levator function in patients with adult onset myogenic ptosis may be an inaccurate measure of true levator palpebrae strength. Reliance on levator function alone in decision making for surgical intervention in these patients may be misguided. The inclusion of the intraoperative maneuvers of incorporation of the levator aponeurosis into the skin incision and preservation of fat and skin results in a stronger eyelid crease after frontalis sling surgery.
authors.affiliation: *Department of Ophthalmology and Visual Sciences; †Department of Otolaryngology - Head and Neck Surgery; and ‡Department of Biostatistics, University of Iowa Hospitals and Clinics, Iowa City, Iowa; §Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico; and ‖Cincinnati Eye Institute, Cincinnati, Ohio, U.S.A.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Allen
authors.forename: Esther S
authors.initials: ES
authors.lastname: Hong
authors.forename: M Bridget
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Morrison
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Nerad
authors.forename: Keith D
authors.initials: KD
authors.lastname: Carter
mesh_terms: D000368:Aged; D001763:Blepharoptosis / Q000503:physiopathology / Q000601:surgery*; D005141:Eyelid Diseases / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D039141:Muscular Dystrophy, Oculopharyngeal / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D017246:Ophthalmoplegia, Chronic Progressive External / Q000503:physiopathology / Q000601:surgery*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012826:Silicone Elastomers; D013536:Suture Techniques
chemical_list: D012826:Silicone Elastomers