Eyeworld

123 EW INTERNATIONAL October 2016 need to make a correction because of an over- or undercorrection, it will be easier through a transcutaneous approach than a transconjunctival one," Dr. Press said. EW Transcutaneous Traditional ptosis correction, involv- ing a transcutaneous approach and the shortening of the levator muscle to achieve improved eyelid position, differs greatly from Dr. Malhotra's technique and provides better, more easily achieved operative outcomes, according to Uwe Peter Press, MD, Barmherzen Brüder Hospital, Trier, Germany, who also presented at the DOC. He thinks that a transconjunc- tival approach has several decided disadvantages. "When you operate transconjunctivally, you need to evert the lid, which can be very uncomfortable for the patient. Also, from an anatomical point of view, it is not as easy to dissect the lid mus- cles as it is transcutaneously. I would say it is far more challenging ana- tomically, and I performed transcon- junctival ptosis surgery frequently before switching to transcutaneous." Dr. Press explained that a transconjunctival ptosis approach could damage the meibomian glands, which create vital lipids found in the tear film. "Removing even a part of these glands during a ptosis operation in older patients in whom dry eye is already an issue can make it much worse," he explained. He said that the creation of an eye crease would be harder to do using a posterior approach. "Once you dissect part of the levator mus- cle, you need to place skin sutures to create a furrow, depending on the surgeon. But you will never manage to create a lid crease as well as you can transcutaneously." Older patients frequently pres- ent with extra lid skin, which can contribute to obscuring vision if it is not reduced. "There is no sense correcting lid height with ptosis surgery in elderly patients if you do not resect the extra skin because it will sag over the edge of the lid. Using the transcutaneous method, you can perform upper lid bleph- aroplasty alongside ptosis surgery easily. With the transconjunctival method, however, you need to make a second transcutaneous incision to carry out the upper lid blepharo- plasty. This is an additional surgery, which is not practical. As a surgeon I want to simplify things because surgery is complicated enough. If I make it overcomplicated from the get-go, then I might create unnec- essary complications. Finally, if you Editors' note: Drs. Malhotra and Press have no financial interests related to their comments. Contact information Malhotra: raman@ramanmalhotra.com Press: augenabteilung@bk-trier.de Innovative trifocal technology When freedom becomes reality FINE TECHNOLOGY by PhysIOL [NEAR] [INTERMEDIATE] [FAR] Beyond the limits of vision AAO Chicago - BOOTH #4504 www.physiol.eu

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