Levator plication versus resection in congenital ptosis - a prospective comparative study

Area of Science:

• Ophthalmology
• Surgical Techniques
• Congenital Disorders

Background:

• Congenital ptosis, a common eyelid condition, affects eyelid height and visual axis.
• Surgical correction aims to improve eyelid function and cosmesis.
• Levator muscle surgery is a primary treatment modality.

Purpose of the Study:

• To compare the efficacy of levator plication versus levator resection in correcting congenital ptosis.
• To evaluate postoperative eyelid height and complication rates between the two surgical techniques.

Main Methods:

• Prospective comparative randomized trial with 20 patients (20 eyes).
• Inclusion criteria: age > 4 years, simple mild-to-moderate congenital ptosis, good-to-fair levator action.
• Randomization to either levator resection or plication, with outcomes assessed over 3 months.

Main Results:

• Levator resection resulted in a significantly higher mean Marginal Reflex Distance 1 (MRD1) at 3 months (2.8 mm) compared to plication (1.12 mm; p=0.001).
• Plication showed limited improvement in levator function.
• Levator resection led to more postoperative issues including Bell's phenomenon alterations, lid lag, lagophthalmos, and persistent edema in 3 cases.

Conclusions:

• Levator resection achieves good cosmetic outcomes in 70% of congenital ptosis cases.
• Levator plication is associated with a higher risk of recurrent ptosis from the fourth week post-surgery.
• Plication technique, despite its simplicity, is less effective in correcting dystrophic muscles in congenital ptosis.