The Outcome of Levator Advancement for Correction of Blepharoptosis in Patients with Myasthenia Gravis

Purpose: To describe the results of Levator advancement for correction of blepharoptosis in patients with myasthenia gravis (MG). Methods: a retrospective study, using the palpebral fissure height as the main outcome measure for assessment of the effect of levator advancement in patients with MG who did not respond to medical therapy at the Saudi German Hospitals Group between 2002 and 2004. Results: Twelve external Levator advancement procedures for correction of ptosis were performed on 9 patients with MG. Eight of the 9 patients had ocular MG and one had systemic MG. Patients were followed postoperatively for an average of 16.6 months (range, 12-36 months). The amount of ptosis was measured pre-and postoperatively. Six patients showed a statistically significant improvement in the mean palpebral fissure height from 2 mm preoperatively to 7.5 mm postoperatively, with a mean difference of 3.95 mm (95% confidence interval 1.8 mm to 5.8 mm, p = 0.0042). Postoperative complications included worsened diplopia in two patients and exposure keratopathy in one patient. Two patients developed recurrent ptosis that required second intervention after 1.5 and 2 years consequently. Conclusions: Levator advancement procedures can attain eyelid elevation in patients with MG not responding to medical therapy. Possible complications include aggravated diplopia and exposure keratopathy.