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CC BY-NC 4.0 · Arch Plast Surg 2018; 45(02): 165-170
DOI: 10.5999/aps.2017.00465
Original Article

Tarsal switch using an anterior approach to correct severe ptosis

Roberta Lilian Fernandes de Sousa Meneghim
Department of Ophthalmology, Faculdade de Medicina de Botucatu-UNESP, São Paulo, Brazil
,
Lucieni Barbarini Ferraz
Department of Ophthalmology, Faculdade de Medicina de Botucatu-UNESP, São Paulo, Brazil
,
Alicia Galindo-Ferreiro 
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain
,
Rajiv Khandekar
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
,
Hortensia Sanchez-Tocino
Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain
,
Silvana Schellini
Department of Ophthalmology, Faculdade de Medicina de Botucatu-UNESP, São Paulo, Brazil
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Background To present the outcomes of the tarsal switch procedure using an anterior approach to correct severe ptosis with poor levator muscle function (<4 mm) with absent or poor Bell’s phenomenon.

Methods This retrospective case series included 11 patients with severe neurogenic or acquired myogenic palpebral ptosis. All patients underwent the tarsal switch procedure through an anterior approach from 2012 to 2015. Margin reflex distance (MRD1 and MRD2) and the palpebral fissure were evaluated preoperatively and postoperatively. Data were compared using the Wilcoxon signed-rank test. P-values <0.05 were considered to indicate statistical significance.

Results Surgery was performed on 18 eyelids (11 patients). The median age at surgery was 57 years (range, 29-86 years). Four patients had unilateral ptosis and seven had bilateral ptosis. Nine patients had myogenic ptosis and two had neurogenic ptosis. Postoperatively, the chin-up position improved in all patients. The MRD1 increased statistically significantly, from 0 mm preoperatively to 1.0 mm postoperatively (P=0.001). The MRD2 decreased statistically significantly, from 4.5 mm preoperatively to 3.0 mm postoperatively (P=0.001). The palpebral fissure did not change (4.0 mm preoperatively to 4.0 mm postoperatively) (P=0.13).

Conclusions The tarsal switch procedure through an anterior approach is an effective alternative for correcting severe ptosis, especially neurogenic or acquired myogenic ptosis. This procedure can be performed with minimal risk of ocular surface exposure and provides stable outcomes.

Keywords

Blepharoptosis - Transplantation - Transplants


Publication History

Received: 10 March 2017

Accepted: 28 February 2018

Article published online:
22 May 2022

© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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