Comparative evaluation of "closed posterior levator advancement" in simple congenital and aponeurotic ptosis

PURPOSE: The purpose of this study was to compare the outcomes of "closed posterior levator advancement" (CPLA) in acquired aponeurotic and simple congenital ptosis with good levator function (LF). MATERIALS AND METHODS: A prospective interventional study was conducted on 20 adult patients, 10 simple congenital ptosis, and 10 acquired aponeurotic ptosis with LF >= 8 mm. Complicated, posttraumatic, neurogenic ptosis and previous lid surgery were excluded. A detailed history and assessment of visual acuity, upper eyelid margin reflex distance (MRD1), margin-crease distance, LF, Bell's phenomenon, ocular surface disease index (OSDI), and phenylephrine test were undertaken. CPLA was performed in the 20 eyes and were followed up for 3 months. RESULTS: The ages of the study participants ranged from 18 to 64 years, and the male: female ratio was 11:9. There were nine aponeurotic and one congenital severe ptosis, the remaining 10 being mild-moderate ptosis. The etiologies in the aponeurotic group were involutional (2), contact lens wear (1), allergic conjunctivitis (3), and idiopathic in four eyes. The success rates were 90% in both groups. The amount of ptosis correction showed a positive relation with LF (r(s) = 0.6, P = 0.004) and phenylephrine test (r(s) = 0.7, P < 0.001). The complications in the aponeurotic group were lagophthalmos (2/10), subjective dry eye (2/10), subconjunctival hemorrhage (1/10), symblepharon (1/10), temporal flare (1/10), and overcorrection (1/10). The congenital group showed only undercorrection (1/10). CONCLUSION: CPLA is an effective procedure for the treatment of mild-moderate simple congenital and all grades of aponeurotic ptosis with good LF. Response to phenylephrine test serves as a useful guide to the amount of ptosis correction.