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Intraoperative lagophthalmos formula for levator resection in congenital ptosis
  1. Sunah Kang1,
  2. Ji Won Seo2,
  3. Chan Joo Ahn1,
  4. Bita Esmaeli3,
  5. Ho-Seok Sa1,3
  1. 1 Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  2. 2 Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
  3. 3 Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Ho-Seok Sa, Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea; lineblue{at}


Aim To calculate a regression formula for intraoperative lagophthalmos to determine the amount of correction in levator resection for mild to moderate congenital ptosis.

Methods This retrospective study included 38 eyelids from 28 consecutive children with congenital ptosis with levator function of 4 mm or better who showed satisfactory surgical outcomes defined as postoperative margin reflex distance-1 (MRD1) ≥3 mm in each eye and difference in MRD1 ≤1 mm between eyes at 6 months after levator resection. We investigated whether the degree of intraoperative lagophthalmos measured by calliper correlated with the preoperative values of MRD1, levator function and age. A stepwise multiple regression analysis was performed with intraoperative lagophthalmos as the dependent variable.

Results The mean intraoperative lagophthalmos was 7.4±0.9 mm (range, 6–10 mm). The intraoperative lagophthalmos was found to have a statistically significant negative correlation with preoperative MRD1 (r2 =0.55, p<0.0001) and levator function (r2 =0.53, p<0.0001), respectively. A stepwise multiple regression analysis resulted in the following regression formula: Intraoperative lagophthalmos=9.08 – 0.48×Preoperative MRD1 – 0.26×Levator function (r2 =0.60, p<0.0001).

Conclusion Intraoperative lagophthalmos in patients with satisfactory surgical outcome correlated negatively with both preoperative MRD1 and levator function and accounting for both variables resulted in a stronger correlation than either variable alone. Surgeons would be able to calculate the amount of surgical correction using this formula of intraoperative lagophthalmos, which could lead to a satisfactory surgical outcome in levator resection for congenital ptosis.

  • eye lids
  • treatment surgery

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  • Contributors Conception and design: H-SS. Analysis and interpretation of data: all authors. Drafting the article or revising it critically for important intellectual content: SK, BE, H-SS. Final approval of the version to be published: H-SS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained. 

  • Ethics approval Institutional Review Board of the Ethics Committee of Asan Medical Center, Seoul, Korea. 

  • Provenance and peer review Not commissioned; externally peer reviewed.

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