Superior tarsectomy augments super-maximum levator resection in correction of severe blepharoptosis with poor levator function.

Objective: To 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).

Methods: Retrospective, consecutive case series. Methods: Patients who underwent super maximum levator resection with (8 eyelids) or without superior tarsectomy (10 eyelids) at one institution. Methods: Chart 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. Methods: Margin reflex distance-1 (distance [mm] between corneal light reflex and upper eyelid margin), bilateral eyelid symmetry, and postoperative complications.

Results: A 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.

Conclusions: The super maximum levator resection combined with superior tarsectomy can correct severely ptotic eyelids with Berke levator function ranging from 3 to 4.5 mm.