title: Tarsoaponeurectomy as an alternative in difficult blepharoptosis cases.
abstract: BACKGROUND
  The purpose of this study was to evaluate the results of tarsoaponeurectomy in patients with unsuccessful results after repetitive surgery or who developed post-traumatic blepharoptosis.
  
  
  METHODS
  The files of 107 patients (136 eyes) on whom surgery was performed between January 2010 and December 2014 due to blepharoptosis were scanned retrospectively. Among these patients, the files and operational notes of eight patients who underwent surgery through the method of tarsoaponeurectomy were examined in detail. The epidemiological data, indication for surgery, previous ptosis and/or eyelid surgeries and trauma histories, preoperative and postoperative measurement data (palpebral space (PS), margin reflex distance (MRD1, MRD2), levator muscle function (LMF)) of the patients were recorded. The follow-up time of the patients was 7 to 34 months with an average of 16 months.
  
  
  RESULTS
  A total of eight patients consisting of three females and five males were included in the study. The age range was 19 to 63 years with an average of 39 ± 16.2 years. Four patients had traumatic ptosis history whereas four patients had previous multiple levator procedure surgery history. Those patients with a history of ptosis had undergone surgery with levator procedure at least two times. Additionally, one patient had upper eyelid entropion, one had anophthalmic socket syndrome, and one had exposure keratopathy and traumatic dilated pupil. Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye. All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery. Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed.
  
  
  CONCLUSIONS
  Tarsoaponeurectomy is an alternative method for oculoplastic surgeons used to deal with patients on whom sufficient and desired results have not been achieved despite repetitive surgery and in post-traumatic cases where levator muscle and aponeurosis cannot be dissociated peroperatively.
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey. sysendul@hotmail.com.
authors.forename: Selam Yekta
authors.initials: SY
authors.lastname: Sendul
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey.
authors.forename: Burcu
authors.initials: B
authors.lastname: Dirim
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demir
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Acar
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey.
authors.forename: Atilla Gokce
authors.initials: AG
authors.lastname: Demir
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Olgun
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Tiryaki
authors.affiliation: Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ulucanlar street, 06030, Altındag, Ankara, Turkey.
authors.forename: Cemile
authors.initials: C
authors.lastname: Ucgul
authors.affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Guven
mesh_terms: D000328:Adult; D001763:Blepharoptosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001767:Blinking / Q000502:physiology; D005143:Eyelids / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D009802:Oculomotor Nerve / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013710:Tendons / Q000294:innervation*; D055815:Young Adult