Modified Blaskovics Operation For Ptosis Repair(Transconjunctival Blepharoptosis Surgery)
Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator muscle . In 1923 Blaskovics first described his technique of extensive dissection of the levator muscle from its surrounding structures prior to its resection. Two sets of sutures were used, the first three were through the levator aponeurosis and the cut edge of the conjunctiva and the second three were fold-forming sutures through the levator aponeurosis only, and then both were passed anteriorly through the tarsus and skin. This was combined with a tarsectomy in all cases.
Posterior approach surgery was further addressed by Agatston when he stated in 1942 that this technique was becomingly increasingly popular in the United States. In 1953 Berke , operating mainly on congenital cases, further simplified Blaskovics technique, by using only one set of sutures and no tarsal excision was carried out. Following the early papers demonstrating the technique of anterior approach ptosis repair, posterior approach surgery was preferred when focussing on the posterior lamellar structures; tarsus, conjunctiva and Müller’s muscle.
Live ptosis surgery for congenital ptosis performed by Raman Malhotra
Posterior approach surgery for congenital ptosis. The procedure is a modification of the white line advancement procedure described and reported by Mr Malhotra in the British Journal of Ophthalmology in 2010.
Levator plication ,conjunctival route, Singh technique
Surgery is done after double everting the lid. Through three incisions, levitator is picked from the orbit and fixed to the anterior surface of the tarsal plate. No tissue is removed. Fugo blade is used for a convenient blood less surgery. However other tools can also be used.