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Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity
Published on: September 20, 2024
Refractive error characteristics in patients with congenital blepharoptosis before and after ptosis repair surgery
Ji-Sun Paik1, Su-Ah Kim2, Shin Hae Park1
1Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 137-701, Republic of Korea.
Insights
Congenital blepharoptosis surgery can alter astigmatism patterns, increasing oblique astigmatism. Early correction of refractive errors, especially amblyogenic astigmatism, is crucial to prevent amblyopia in affected children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Surgery
Background:
- Congenital blepharoptosis is a condition affecting eyelid position in children.
- Refractive errors, including astigmatism, are common in patients with congenital blepharoptosis.
- Surgical repair is the primary treatment for congenital blepharoptosis.
Purpose of the Study:
- To investigate the impact of surgical ptosis repair on refractive error patterns in Korean children.
- To analyze changes in astigmatism, specifically its type and severity, before and after surgery.
- To identify the prevalence of amblyopia and its association with refractive errors in this patient group.
Main Methods:
- Retrospective review of clinical records of 54 patients with congenital blepharoptosis (2006-2012).
- Detailed refractive examinations before and after ptosis repair surgery in 21 selected patients.
- Classification of astigmatism into with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism (OA) subgroups.
Main Results:
- Ptotic eyes exhibited more severe astigmatism and a higher prevalence of OA compared to fellow eyes.
- Astigmatism magnitude changes were not significant post-surgery, but OA proportion increased significantly.
- Amblyopia was present in 20.9% of ptotic eyes, with amblyogenic astigmatism being the most common cause (11.9%).
Conclusions:
- Congenital blepharoptosis is associated with more severe astigmatism and a higher incidence of OA.
- Surgical repair may lead to a significant shift towards OA, potentially causing amblyopia.
- Pre- and post-operative correction of astigmatism is vital for preventing amblyopia in patients undergoing ptosis repair.
Background:
We examined the effect of surgical repair on the pattern of refractive errors in Korean patients with congenital blepharoptosis.
Methods:
We reviewed the clinical records of 54 patients with congenital blepharoptosis who attended our hospital from 2006 to 2012 and underwent a detailed refractive examination before and after ptosis repair surgery. Among them, 21 of the patients whose refractive data was available for both before and after the surgery were included in order to observe the effect of ptosis repair surgery on refractive error characteristics. The astigmatism groups were divided into three subgroups: with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism (OA). We also evaluated the severity of astigmatism.
Results:
Before surgery, the ptotic eyes had more severe astigmatism and a greater percentage of OA than the fellow eyes. The changes in astigmatism magnitude before and after surgery were not significant, but the proportion of subjects with OA increased significantly. In ptotic eyes, amblyopia was found in 14 eyes (20.9 %). 3 eyes (4.5 %) were from solely occlusive visual stimulus deprivation due to severe ptosis, and 11 eyes were from refractive errors. Among refractive errors, amblyogenic astigmatism made up to the largest proportion of patients (8 patients, 11.9 %).
Conclusions:
Ptotic eyes had more severe astigmatism and more OA than fellow eyes. Amblyogenic astigmatism was more common in ptotic eyes. A change in astigmatism toward the OA axis was significantly detected after surgery, and that can be possible amblyogenic cause. Therefore, the correction of astigmatism before and after ptosis repair surgery is very important to prevent amblyopia.
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