Outcomes of anterior levator resection in congenital blepharoptosis

To identify any consistent factors which may predict over- or undercorrection of congenital blepharoptosis treated by anterior levator resection.

A retrospective case note review of 100 consecutive patients undergoing anterior levator resection for congenital blepharoptosis was performed to identify: (1) the amount of ptosis and degree of levator function present pre-operatively and (2) the surgical outcome. For unilateral ptosis, a successful result was defined as a lid level within 1 mm of the fellow lid following a single operation.

Seventy-six per cent of all unilateral cases had a successful outcome at 6 weeks following surgery, falling slightly to 74% by 6 months. The most common complications at 6 months were undercorrection (19%) and overcorrection (7%). All patients undercorrected at 6 months had a pre-operative levator function in the range of 4-10 mm with a mean of 6.4 mm, whereas all those overcorrected at 6 months had a levator function in the range 9-15 mm with a mean of 12.2 mm. In the whole population, the degree of levator function was a predictor of increased risk of overcorrection, with a trend towards predicting undercorrection as well.

In this series of patients, pre-operative levator function was found to be the most significant predictor of surgical outcome for anterior levator resection.