Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis

Purpose: To evaluate, in patients with acquired good-function blepharoptosis, levator advancement success and surgical failure risk factors. Methods: This retrospective, case-cohort study was university based. An estimated 828 patients underwent levator advancement for acquired good-function blepharoptosis between January 1, 1990, and December 31, 1999. Seventy-two patients underwent reoperation during the first postoperative year. Of 125 randomly selected patients not undergoing reoperation, 106 met the desired outcome criteria: postoperative margin reflex distance (MRD) greater than or equal to2.0 mm and less than or equal to4.5 mm in operated eyes and less than or equal to1.0 mm asymmetry between eyelids. Mean MRD, levator function, and Hering dependence (ipsilateral eyelid elevation exacerbating contralateral blepharoptosis) prevalence were determined for reoperated and desired-outcome groups and compared by using 2-sample t test and the Fisher exact test, respectively. Multivariate analysis was also performed. Results: Reoperative rates were 8.7% overall, 5.2% of unilateral, and 13% of bilateral cases. Fourteen percent of patients had results outside the desired range but declined reoperation. Univariate analysis revealed significant differences in preoperative characteristics between desired and undercorrected groups: MRD, 1.0 versus 0.32 mm (p=0.001); levator function, 15.4 versus 14.7 turn (p=0.013); and Hering dependence, 50% versus 79% (p=0.005). With multivariate analysis, bilateral blepharoptosis was statistically significant (p=0.014), whereas levator function and Herring dependence were not. No differences were seen between desired and overcorrected groups. Conclusions: After levator advancement for acquired good-function blepharoptosis, 77% of patients had ideal results and 8.7% underwent reoperation. Patients with bilateral or severe blepharoptosis have increased risk of undercorrection.