Levator Aponeurosis and Muller Muscle Plication Reinforced With Levator Sheath Advancement for Blepharoptosis Correction.

The authors innovated the levator aponeurosis and Muller muscle plication reinforced with levator sheath advancement (AMPSA) for blepharoptosis correction. The orbital septum was opened 1 mm above its fusion with the levator aponeurosis. The preaponeurotic fat was retracted and the thickened part of the levator sheath was identified. Two plication sutures were made: medial suture at the medial border of the pupil and lateral between the lateral border of the pupil and the lateral limbus. A needle with 6-0 nylon thread first bit the tarsal plate approximately 1 mm below its upper border, then bit the levator aponeurosis and the Muller muscle together at 3 to 6 mm above the upper border of the tarsal plate. The needle bit 1 to 3 mm of the thickened part of the levator sheath and the suture was tied. A total of 116 eyes were operated on using levator aponeurosis and Muller muscle plication (AMP), and 79 eyes using AMPSA. The mean follow-up period was 11.4 months. In the AMP group, the postoperative marginal reflex distance-1 (MRD-1) (3.8 ± 0.2 mm) was significantly greater than the preoperative MRD-1 (2.7 ± 0.3 mm) (P < 0.001). In the AMPSA group, the postoperative MRD-1 (3.5 ± 0.3 mm) was also significantly greater than the preoperative MRD-1 (1.7 ± 0.4 mm) (P < 0.001). The improvement in MRD-1 was greater in the AMPSA group (1.7 ± 0.4 mm) than in the AMP group (1.1 ± 0.3 mm) (P < 0.001). The difference in the MRD-1 outcome between AMPSA and AMP (0.6 mm) was obtained by advancing the thickened part of the levator sheath. AMPSA may be an effective procedure for correcting blepharoptosis.