Aponeurotic Ptosis: A Retrospective Case Series of Transconjunctival White Line Advancement and Review of Literature.

PURPOSE: To describe our experience with transconjunctival white line advancement surgery in aponeurotic ptosis patients with fair to good levator function.

METHODS

A retrospective analysis was conducted on 23 eyes with mild to severe involutional ptosis that underwent white line advancement surgery over a 1-year period. All patients demonstrated fair to good levator function. Preoperative data collected included demographics, marginal reflex distance 1 (MRD1), vertical palpebral aperture height (VPA), lid crease distance, levator function, Bell's phenomenon, extraocular movements, and icepack test. The surgical technique involved identification of the white line following dissection of the conjunctiva-Müller muscle complex. The levator was advanced using a double-armed 5-0 polyglactin suture along the anterior surface of the tarsus, exteriorized at a pre-marked point.

RESULTS

Twenty patients achieved optimal correction in terms of MRD1 and VPA, with normal lid contour and good lid-globe apposition. One eye was undercorrected, and one patient each exhibited medial notching and lateral flare. No patients developed postoperative lagophthalmos, ocular surface abnormalities, or discomfort. The overall success rate was 86.95%.

CONCLUSIONS

Transconjunctival white line advancement is a significant modification in ptosis surgery with a short learning curve. The technique is easily reproducible, with a high success rate and excellent cosmetic outcomes.