Frontalis Linkage Without Intraoperative Eyelid Elevation for the Management of Myopathic Ptosis
Ophthalmic Plast Reconstr Surg
Stefânia B. Diniz, Patricia Akaishi, Antonio A. V. Cruz
Correcting severe eyelid ptosis is often challenging, especially in myopathic patients. These cases usually have eye motility limitation, a weak levator muscle and reduced eye protective mechanisms such as Bell’s reflex and orbicularis muscle strength. Therefore, they are in high risk of corneal exposure and spontaneous keratopathy.
In our study we did a retrospective analysis of 21 myopathic patients who underwent frontalis linkage to correct eyelid ptosis. Surgery consisted of using an autogenous fascia sling to link the tarsal plate to the frontalis muscle without any degree of intraoperative eyelid elevation.
Our patients had the margin reflex distance 1 (MRD1) increased to 1.4mm ± 1.34 SD and with full frontalis contraction it reached 3.0mm ± 1.73 SD, while mean brow position decreased 1.6mm ± 1.59 SD, p < 0.0001. The mean brow excursion was 5.3 mm, which means these patients still have enough frontalis strength, that can be transmitted to the eyelid. Postoperative lagophthalmos was not detected in 31 (74%) eyes. In the remaining 11 eyes (26%), lagophthalmos ranged from 1.2 to 5.2mm (mean = 1.7mm ± 0.74 SD).
In conclusion, frontalis linkage using autogenous fascia is a good option in myopathic ptosis. The goal of this procedure is to perform a dynamic lid elevation with no intraoperative eyelid suspension so that the eye opening is conditioned to the frontalis contraction, promoting a safe and conservative correction of the ptosis.