Small-incision levator resection for correction of congenital ptosis: a prospective study

To determine the rate of success of small-incision levator resection technique for correction of congenital ptosis.

Patients with congenital ptosis who were candidates for levator resection were enrolled if their levator function was not poor (< 5 mm). Incisions were made on upper eyelid crease with a length of 10-12 mm. After resection of adequate length of levator muscle, two sutures were used to fix it to tarsal plate. Sliding the incision to medial and lateral sides provided a wider field of access to allow the surgeon to place the sutures above nasal and temporal borders of limbus. Success was defined as margin reflex distance-1 (MRD-1) ≥ 3 mm and inter-eyelid difference of MRD-1 less than 1 mm, which was considered excellent if inter-eyelid difference was < 0.5 mm and good if the latter parameter was between 0.5 and 1 mm.

Fifty eyes of 47 congenital ptosis cases (16 males and 31 females) were included. Average age was 21.7 ± 9.7 years (range, 3-44 years). Mean preoperative levator function and MRD-1 were 11.26 ± 2.79 and 1.78 ± 0.92 mm, respectively, while postoperative MRD-1 increased to 3.95 ± 0.82 mm (P < 0.001). The result was failure (undercorrection) in 12 cases (25.5%), good in 9 patients (19.2%), and excellent in 26 cases (55.3%).

Small-incision levator resection has previously been studied for correction of aponeurotic ptosis and proved to yield successful outcome. The findings of this study suggest that small-incision technique can be effectively used in correction of congenital ptosis, as well.