The Posterior Approach Tarsal Switch Procedure for Myopathic Ptosis: A Modified Technique

Purpose: The surgical management of myopathic ptosis remains a challenge. The authors report the results of a modified posterior approach tarsal switch technique, which raises both the upper and lower eyelids and reduces the risk of corneal exposure in these patients. Methods: A modified tarsal switch technique is described. A tarsoconjunctival and Muller's muscle graft is harvested via a posterior approach from the upper eyelid, the defect closed, and the graft transferred to the lower eyelid. Results: The procedure was performed on 16 eyelids of 9 patients. No adjunctive procedures were performed. The patients ranged in age from 36 years to 79 years. All patients had bilateral myopathic ptosis, reduced levator function, and a poor Bell's response. The margin reflex distance-1 increased by 1.5 to 4.5 mm (mean 2.3 mm) and the margin reflex distance-2 decreased by 0.5 to 2.5 mm (mean 1.6 mm). There were no intraoperative complications, no significant corneal exposure problems, and no patients required revision surgery over a follow-up period of 6 to 52 months (mean 16 months). Conclusions: This technique of harvesting the tarsoconjunctival-Muller's muscle graft posteriorly, closing that defect and transferring the graft into the lower eyelid to elevate it, is an effective surgical procedure for the management of ptosis in patients with poor ocular protective mechanisms.

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