Outcomes Of Adult Aponeurotic Ptosis Repair Under General Anaesthesia By A Posterior Approach White-Line Levator Advancement

Aponeurotic ptosis surgery is conventionally performed under local anaesthetic to allow adjustment of eyelid height and contour. This may not be possible where general anaesthesia (GA) is required.Purpose: We describe our experience using a tranconjunctival posterior approach "white-line" levator advancement (WLA) in patients undergoing aponeurotic ptosis correction under a GA.Materials and Methods: Retrospective review of a consecutive series of 20 patients with primary aponeurotic ptosis undergoing posterior approach WLA ptosis repair under GA. The procedure involves exposing the posterior surface of the levator aponeurosis and advancement through tarsus onto its anterior surface if exposed already, or to skin. All patients underwent pre-and postoperative photographs and final outcomes were assessed at minimum 3 months. Outcome measures included pre-and post-marginal reflex distance (MRD), symmetry of height, contour, fold and complications including dry eye.Results: Twenty patients undergoing 40 procedures were included. Mean age was 58 (22-87) years. Mean preoperative MRD was 1.3. Preoperative phenylephrine test was positive all patients. The mean postoperative MRD was 3.5 mm. Although all 20 patients achieved their desired lid height and contour, one patient had a 2 mm asymmetry, with a final success rate of 95% (19/20 patients).Conclusion: We suggest that a posterior approach white-line advancement is an ideal technique to correct even severe aponeurotic ptosis in patients requiring surgery under GA. Preoperative positive phenylephrine test is a good predictor of postoperative height and contour without the need for per-operative adjustment.Precis: Aponeurotic ptosis surgery for patients under general anaesthesia using a simple posterior approach white-line advancement achieves predictability of lid height, symmetry and contour and is an ideal option for phenylephrine-positive ptosis.