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Outcomes of Early Correction of Congenital Myogenic Ptosis Using Transconjunctival Levator Plication
Zoran Zikić1,2, Milorad Ljutica1,3, Reuf Karabeg4,5
1"Milos Clinic" Eye Hospital, Belgrade, Serbia.
Insights
Early surgical correction of congenital myogenic ptosis in young children using transconjunctival levator muscle plication can yield satisfactory outcomes, even when levator function is difficult to measure.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Oculoplastics
Background:
- Congenital ptosis correction is vital to prevent amblyopia and abnormal head posture.
- Measuring levator function in very young children poses a significant challenge for surgical planning.
Purpose of the Study:
- To analyze the efficacy of early surgical correction for congenital myogenic ptosis in pediatric patients.
- To evaluate outcomes of transconjunctival levator muscle plication in cases where levator function is unmeasurable.
Main Methods:
- Retrospective case series involving 12 eyes of 12 patients with unilateral congenital myogenic ptosis.
- Surgical intervention via transconjunctival levator muscle plication.
- Pre- and postoperative measurements included upper lid margin to corneal reflex (MRD1) and upper lid skin crease height (UEC). Phenylephrine testing was also performed.
Main Results:
- 50% of patients achieved symmetrical upper lid height post-surgery.
- 33% experienced mild hypocorrection (up to 1 mm), with one case requiring revision surgery.
- Significant improvement in upper lid skin crease height difference was observed (2.16 mm preoperatively to 0.41 mm postoperatively).
Conclusions:
- Transconjunctival levator plication is a viable surgical option for congenital myogenic ptosis in young children.
- Satisfactory aesthetic and functional outcomes can be achieved despite challenges in pre-operative levator function assessment.
- This technique offers a good alternative for ptosis correction when precise levator function measurement is not feasible.
Introduction:
Early correction of congenital ptosis may be indicated due to a risk of amblyopia or because of an abnormal head tilt. One of the main problems, of planning ptosis surgery in very young children, is the inability to measure the levator function.
Aim:
The aim of the article was to analyze the early correction of congenital myogenic ptosis.
Methods:
This was a retrospective, interventional, case series study, conducted on 12 eyes of 12 patients with unilateral, mild to moderate, congenital myogenic ptosis. Surgical correction of ptosis was performed by transconjunctival levator muscle plication. Pre- and postoperative measurements of the upper lid margin to central corneal reflex (MRD1) and upper lid skin crease height (UEC) were obtained, as well as the presence or absence of a reaction to topically applied phenylephrine 2.5% solution.
Results:
The mean age of the patients was 29.83 months (range 14-45 months). A negative phenylephrine test was noted in only 3 (25%) of cases. Equalization of upper lid height was achieved in 6 (50%), and a hypocorrection of up to 1 mm was noted in 4 (33%) of patients. There was only 1 hypercorrection of 1 mm, noted in the first postoperative month. In one case of hypocorrection of 2 mm, the height of the lid dropped between the 1 and 3 months follow up. Subsequent revision surgery was performed, with a good outcome. With regard to the upper lid skin crease height (UEC), the mean preoperative difference in relation to the contralateral (non-operated) lid, was 2.16 mm, whereas the average postoperative or final difference was 0.41 mm.
Conclusion:
Correction of myogenic ptosis in small children, using transconjunctival levator plication, in whom levator function cannot be measured, may have a satisfactory postoperative outcome.
