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Lee and Lew: Eyelid Contour Analysis Following Müller's Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(6): 627-633.

Published online: 16 June 2017

DOI: https://doi.org/10.3341/jkos.2017.58.6.627

Eyelid Contour Analysis Following Müller's Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis

Sang Min Lee, MD, Helen Lew, MD, PhD

Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Address reprint requests to Helen Lew, MD, PhD. Department of Ophthalmology, CHA Bundang Medical Center, #59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: 82-31-780-5330, Fax: 82-31-780-5333, eye@cha.ac.kr

Received 16 March 2017       Revised 24 April 2017       Accepted 28 May 2017

©2017 The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze both the effects and the eyelid contour of Müller's muscle-conjunctival resection and levator aponeurosis advancement in patients with mild to moderate belpharoptosis.

Methods

We conducted a retrospective cross-sectional study including 20 eyes of 16 patients who underwent Müller's muscle-conjunctival resection and 25 eyes of 17 patients who underwent levator aponeurosis advancement from January 2012 to December 2015, where each patient was followed up for at least 6 months. Surgical success was defined as either a marginal reflex distance 1 (MRD1) elevation greater than 2.5 mm postoperatively or a bilateral MRD1 difference less than 0.5 mm. Both the conventional and 12 oblique mid-pupil lid distances were measured every 15 degrees using custom software developed in the MATLAB program (MathWorks, Natick, MA, USA).

Results

The average correction of Müller's muscle-conjunctival resection was 1.1 mm, while that of levator aponeurosis advancement was 0.9 mm. There was no significant difference in MRD1, MRD2, function of levator palpebrae muscle, or lid contour in the preoperative status between the Müller's muscle-conjunctival resection group and the levator aponeurosis advancement group. The surgical success rate was 85% in the Müller's muscle-conjunctival resection group and 84% in the levator aponeurosis advancement group, but this difference was not significant. The postoperative lid contour (superomedial side, 15°) was more effective in the Müller's muscle-conjunctival resection group (p < 0.05).

Conclusions

Overall, both types of blepharoptosis surgery were effective at correcting mild to moderate blepharoptosis. The correction of mild to moderate blepharoptosis using Müller's muscle-conjunctival resection is an effective technique for elevating the eyelid and normalizing the eyelid contour.

Keywords: Blepharoptosis, Eyelid contour, Levator aponeurosis advancement, Müller's muscle-conjunctival resection

Figures and Tables

Figure 1

Measurement of marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), and brow to pupil distance (BPD). MRD1, MRD2, BPD are measured by Image J program (NIH, Bethesda, MD, USA).

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Figure 2

Eyelid contour analysis. Equally spaced multiple radial mid-pupil lid lines (15°) by MATLAB program (MathWorks, Natick, MA, USA).

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Figure 3

Polar plot of lid contour of preoperative of ptosis patients. (A) Müller's muscle-conjunctival resection group. (B) levator aponeurosis advancement group. (C) Comparision with two groups. MMCR Pre-OP = preoperative lid contour of Müller's muscle-conjunctival resection group; LAA Pre-OP = preoperative lid contour of levator aponeurosis advancement group.

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Figure 4

Polar plot of lid contour between preoperative and postoperative ptosis patients. (A) Müller's muscle-conjunctival resection group. (B) Levator aponeurosis advancement group. MMCR Pre-OP = preoperative lid contour of Müller's muscle-conjunctival resection group; MMCR Post-OP = postoperative lid contour of Müller's muscle-conjunctival resection group; LAA Pre-OP = preoperative lid contour of levator aponeurosis advancement group; LAA Post-OP = postoperative lid contour of levator aponeurosis advancement group.

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Figure 5

Polar plot of postoperative lid contour between Müller's muscle-conjunctival resection group and levator aponeurosis advancement group. The postoperative lid contour (superomedial side, 15°) was more effective in the Müller's muscle-conjunctival resection group (p < 0.05). MMCR Post-OP = postoperative lid contour of Müller's muscle-conjunctival resection group; LAA Post-OP = postoperative lid contour of levator aponeurosis advancement group.

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Table 1

Demographic characteristics of the subjects

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Values are presented as mean ± SD unless otherwise indicated.

MMCR = Müller's muscle-conjunctival resection; LAA = levator aponeurosis advancement; MRD1 = marginal reflex distance 1; MRD2 = marginal reflex distance 2; BPD = brow to pupil distance.

Table 2

Comparison of preoperative mid-pupil lid distance between MMCR group and LAA group

jkos-58-627-i002

Values are presented as mean ± SD unless otherwise indicated.

MMCR = Müller's muscle-conjunctival resection; LAA = levator aponeurosis advancement.

*Independent t-test.

Table 3

Comparison of mid-pupil lid distance between pre-, postoperative and increment in MMCR group and LAA group

jkos-58-627-i003

Values are presented as mean ± SD unless otherwise indicated.

MMCR = Müller's muscle-conjunctival resection; LAA = levator aponeurosis advancement.

*Paired t-test; †Independent t-test.

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