Superior Tarsectomy Augments Super-Maximum Levator Resection in Correction of Severe Blepharoptosis with Poor Levator Function

ObjectiveTo determine if a superior tarsectomy improves the ptosis corrective ability of the super maximum levator resection in cases of severe blepharoptosis with poor levator function (less than 5 mm).DesignRetrospective, consecutive case series.ParticipantsPatients who underwent super maximum levator resection with (8 eyelids) or without superior tarsectomy (10 eyelids) at one institution.MethodsChart review of patients who underwent super maximum levator resection with or without superior tarsectomy. Data regarding eyelid position, surgical outcome, and postoperative complications were evaluated.Main Outcome MeasuresMargin reflex distance-1 (distance [mm] between corneal light reflex and upper eyelid margin), bilateral eyelid symmetry, and postoperative complications.ResultsA statistically significant improvement in ptosis correction was demonstrated when integrating the superior tarsectomy with the super maximum levator resection (P = 0.029). In addition, the superior tarsectomy significantly decreased the incidence of undercorrection (margin reflex distance-1 values less than 2.0 mm) compared with the super-maximum levator resection alone (12.5% vs. 70%; P = 0.023). Improved postoperative eyelid symmetry within 1.0 and 1.5 mm was demonstrated in cases treated by the superior tarsectomy. Postoperative complications were similar in both treatments.ConclusionsThe super maximum levator resection combined with superior tarsectomy can correct severely ptotic eyelids with Berke levator function ranging from 3 to 4.5 mm.