Analysis of long-term outcomes after surgery in patients with severe blepharoptosis

Background Blepharoptosis is the drooping of the margin of the upper eyelid, which narrows the palpebral fissure and makes it difficult to open the eye. Various surgical methods are used to correct blepharoptosis and have been investigated in different studies. After surgery, blepharoptosis can relapse over time, which affects a patient's satisfaction with the operation. However, few studies have investigated the long-term outcomes of patients after blepharoptosis surgery. Methods From 1991 to 2013, 325 patients (480 eyelids) underwent frontalis muscle transfer or Muller- aponeurosis composite flap advancement in our clink. We analyzed 12. patients (13 eyelids) with severe ptosis who had been followed-up for more than 5 years. Six patients underwent frontalis muscle transfer for the correction of seven eyelids, while Muller-aponeurosis composite flap advancement was performed on six patients (six eyelids). The marginal reflex distance (MRD1), area of corneal exposure (ACE), and height of the eyebrow were used to analyze the objective outcomes, and the Glasgow Benefit Inventory questionnaire was used for the analysis of subjective patient satisfaction. Results There were no significant differences in the MRD1, ACE, and eyebrow height between the two methods used to correct ptosis. However, over the long-term (>5 years), the MRD1, ACE, and eyebrow height were better maintained in patients who underwent Muller-aponeurosis composite flap advancement than in patients who received frontalis muscle transfer. Conclusions Both surgeries were effective for blepharoptosis correction. However, Muller-aponeurosis composite flap advancement was better for long-term maintenance after surgery than frontalis muscle transfer.