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Levator resection for congenital ptosis: Does pre-operative levator function or degree of ptosis affect successful
Chinh T Nguyen1, Thomas G Hardy1,2,3
1a Orbital, Plastic & Lacrimal Unit , Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.
Insights
Pre-operative levator function and ptosis degree influence surgical success in children with congenital ptosis undergoing anterior levator resection. A minimum levator function of 8 mm predicts a successful outcome.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital ptosis is a common condition in children requiring surgical correction.
- Anterior levator resection is a standard surgical approach for congenital ptosis.
Purpose of the Study:
- To evaluate the impact of pre-operative levator function and ptosis degree on surgical outcomes in pediatric congenital ptosis.
- To identify predictors of successful surgical outcomes in anterior levator resection.
Main Methods:
- Retrospective cohort study of children with simple congenital ptosis undergoing anterior levator resection under general anesthesia.
- Analysis of pre-operative levator function, degree of ptosis, and surgical success (desired lid height achievement).
Main Results:
- Overall success rate for primary cases was 86%.
- Pre-operative levator function of at least 8 mm was associated with successful outcomes.
- Trends showed greater resection for lower levator function and higher ptosis degree.
Conclusions:
- Anterior levator resection in children is an imprecise procedure.
- Pre-operative levator function is a key factor in predicting successful surgical outcomes for congenital ptosis.
- Patients with levator function ≥ 8 mm have a higher likelihood of successful surgical correction.
Abstract:
The aim of this study was to determine whether pre-operative levator function and degree of ptosis affect surgical outcomes in children with congenital ptosis undergoing anterior levator resection under general anaesthesia. Retrospective cohort study. Children with 'simple' congenital ptosis who underwent anterior levator resection under general anaesthesia. Consecutive cases were reviewed with regards to achievement of the desired lid height (surgical success), and the influence of preoperative levator function and degree of ptosis. The amount of pre-operative levator function and degree of ptosis, with corresponding surgical outcomes. Forty-two lids (37 patients) were included in the study: 36 primary and 6 revision cases (which were excluded from analysis due to small sample size). Mean age was 7 years (range 3-17 years), with similar male to female ratio (1.2:1). The overall success rate for primary was 86%. There were small to moderate trends towards greater amount of levator resection for lower levator function (r2 = -0.25, p < 0.05) and higher degree of ptosis (r2 = 0.38, p < 0.05). All successful primary cases (n = 31) had pre-operative levator function of at least 8 mm. Levator resection in children under general anaesthesia continues to be an imprecise science. Degree of ptosis and levator function were poorly correlated to each other; however, there was an expected small to moderate correlation between resection amount and levator function (negative correlation) or degree of ptosis (positive correlation). Patients with levator function of 8mm or more are likely to have a successful outcome.
