Response to Letter: Upper eyelid platinum weight placement for the treatment of paralytic lagophthalmos: A new plane between the inner septum and the levator aponeurosis

First, I would like to thank you for your interest in and comments on our paper.

In your study, it is stated that “the levator aponeurosis was dissected free from the anterior tarsal surface.” We think that this statement is ambiguous, and interpreted it as indicating that sufficient dissection was performed to fix the gold weight to the levator aponeurosis. It seems that this would require wide dissection, which may lead to unintentional damage to the levator aponeurosis or adjacent tissue. Moreover, the space between the preaponeurotic space and the levator aponeurosis would be very narrow for suture fixation of the uppermost central portion of the levator aponeurosis to the gold weight, and as a result, this could be a traumatic procedure.

In contrast, we performed minimally invasive slit dissection through the tarsal plate to fix the tarsal plate instead of releasing the levator. The width and height of the plate were accurately measured, and the pocket was made and inserted according to the measurements. We also did not fix the uppermost portion of the weight because we created the pocket correctly. Therefore, the plane and the fixation procedure both seem to be different from those described in your study.

Thank you.

Publication History

Received: 15 October 2018

Accepted: 20 October 2018

Article published online:
03 April 2022