title: The utility of margin-reflex distance in determining the type of surgical intervention for congenital blepharoptosis.
abstract: OBJECTIVE
  To evaluate the utility of margin-reflex distance (MRD) as an alternative to levator function (LF) in choosing the appropriate surgical procedure for congenital blepharoptosis.
  
  
  METHODS
  This was a retrospective, observational study.
  
  
  METHODS
  Records of patients with simple (dystrophic) congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm.
  
  
  METHODS
  For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure.
  
  
  RESULTS
  Of one hundred and three eyes of ninety patients (44 female/46 male), levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826.
  
  
  CONCLUSIONS
  The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations.
authors.affiliation: Department of Ophthalmology, Iskenderun State Hospital, Hatay, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Ural
authors.affiliation: Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Mehmet Cem
authors.initials: MC
authors.lastname: Mocan
authors.affiliation: Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Anıl
authors.initials: A
authors.lastname: Dolgun
authors.affiliation: Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Erdener
mesh_terms: D000293:Adolescent; D001699:Biometry / Q000379:methods; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000151:congenital / Q000601:surgery*; D002648:Child; D005143:Eyelids / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome