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Congenital ptosis: results of surgical management
G M Whitehouse1, J R Grigg, F J Martin
1Children's Hospital, Sydney, Australia.
Insights
Surgical correction of congenital ptosis achieved good cosmetic results in most cases. Levator resection is preferred, while brow suspension with fascia lata offers good outcomes with fewer complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital ptosis is a common condition affecting eyelid position in children.
- Surgical intervention is necessary to improve vision and cosmesis.
Purpose of the Study:
- To evaluate the visual and cosmetic outcomes of surgical correction for isolated congenital ptosis.
- To compare different surgical techniques for ptosis repair.
Main Methods:
- Retrospective review of 65 patients (80 eyes) undergoing ptosis surgery.
- Procedures included levator resection, brow suspension with fascia lata, and brow suspension with mersilene mesh.
- Data collected on cosmetic results, recurrence rates, and complications.
Main Results:
- Good cosmetic results achieved in 78 eyes (97.5%).
- Levator resection had a 16.7% recurrence rate; brow suspension with fascia lata had 35%; mersilene mesh had 30%.
- Fascia lata had fewer complications (6%) compared to mersilene mesh (35.3%).
- Reduced visual acuity occurred in 11.25% of eyes.
Conclusions:
- Levator resection is the preferred surgical method for congenital ptosis when feasible.
- Brow suspension with donor fascia lata provides good cosmetic results with low complication rates.
- Congenital ptosis management requires ongoing follow-up to address amblyopia and potential recurrences.
Purpose:
To determine the visual and cosmetic outcome following the surgical correction of isolated congenital ptosis.
Methods:
A retrospective review of the outcome of isolated congenital ptosis corrected under the supervision of one surgeon at The Children's Hospital, Camperdown, between January 1983 and January 1993 was examined. Some 65 patients with 80 involved eyes were identified; 30 eyes underwent a levator resection procedure, 40 eyes underwent a brow suspension using donor stored fascia lata, and in 10 eyes a brow suspension was performed using mersilene mesh.
Results:
In 78 eyes of 63 patients, a good cosmetic result was achieved. In two patients (two eyes) a poor cosmetic result was achieved. These two patients refused further surgery following an undercorrection of their initial ptosis. The recurrence rates for the primary procedures were 16.7% for levator resection procedures, 35% for brow suspension procedures using donor fascia lata, and 30% for brow suspension surgery using mersilene mesh. Some 35.3% of eyes following mersilene slings required further surgery for granulomas and exposed mersilene mesh compared with 6% having similar complications with stored fascia lata. Nine patients (11.25%) had reduced visual acuity (one line or more on the Snellen chart or its equivalent with the other tests used) on the operated side. Only one patient was found to have significant astigmatism.
Conclusions:
An acceptable cosmetic result was achieved with one operation in 75.3% of cases. In 20.8% of cases a second operation was required and in 3.9% of cases three or more operations were required. This series supports the view that where possible, levator resection is the preferred form of surgery to correct congenital ptosis. When the levator function is inadequate, brow suspension is performed. The use of donor fascia lata resulted in a good cosmetic appearance with a low occurrence of surgical side effects. Amblyopia, when strictly defined, occurred in 11.25% of eyes despite early surgery for severe cases and intensive amblyopia therapy. Management requires repeated follow up for early detection and introduction of occlusion therapy or surgical ptosis correction.