title: Minimal incision posterior approach levator plication for aponeurotic ptosis.
abstract: OBJECTIVE
  To assess the efficacy and predictability of a minimal incision posterior approach levator plication technique for correction of involutional ptosis.
  
  
  METHODS
  Retrospective chart review of patients with involutional aponeurotic ptosis underwent minimal incision posterior approach levator plication technique between August 2013 and June 2014 by a single surgeon. The upper lid was double everted, and the conjunctiva and Muller's muscle layers were incised vertically until the levator aponeurosis could be identified. The incision(s) was similar to performing incision and curettage of chalazion, except that the site was above the tarsal plate and extended towards the fornix. Then insertion of aponeurosis was dissected away from the anterior tarsal surface, and the more superiorly located levator was plicated on it with double arm suture(s). No tissue was excised in this procedure. Surgical success was defined as a postoperative margin reflex distance (MRD)>2 mm and<4.5 mm, interlid height<1 mm and satisfactory contour.
  
  
  RESULTS
  Forty-four lids of 27 patients were included. Preoperative mean MRD was 0.48 +/- 0.56 mm. Severe ptosis of MRD<1 mm was present in 34/44 patients (77.3%). The postoperative mean MRD was 2.49 +/- 0.53 mm, and mean improvement was 2.02 +/- 0.61 mm, which was statistically significant (P<0.001). The overall success rate was 38/44 (86.4%).
  
  
  CONCLUSIONS
  Minimal incision posterior approach to levator plication was effective for the correction of aponeurotic ptosis with moderate to good levator function.
authors.affiliation: Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong.
authors.forename: D S
authors.initials: DS
authors.lastname: Ng
authors.affiliation: Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong.
authors.forename: E
authors.initials: E
authors.lastname: Chan
authors.affiliation: Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong.
authors.forename: S T
authors.initials: ST
authors.lastname: Ko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery; D005143:Eyelids / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies