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Modified Maximal Levator Palpebrae Superioris Shortening in Correcting Congenital Severe Ptosis in Children
Ninghua Liu1, Aijuan He, Dan Wu
1From the Department of Facial Plastic and Reconstructive Surgery, Eye and ENT Hospital of Fudan University, Shanghai 200031, China.
Insights
This study shows modified maximal levator palpebrae superioris shortening effectively treats severe congenital ptosis. The procedure offers significant eyelid improvement, even in cases with poor levator muscle function.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Congenital Disorders
Background:
- Severe congenital ptosis significantly impacts vision and aesthetics.
- Effective surgical correction is crucial for functional and cosmetic outcomes.
- Levator palpebrae superioris muscle function is key in eyelid position.
Purpose of the Study:
- To evaluate the clinical efficacy of a modified maximal levator palpebrae superioris shortening method.
- To assess the outcomes for severe congenital ptosis patients, particularly those with poor levator function.
Main Methods:
- Retrospective case series of 66 eyes from 62 patients with severe congenital ptosis.
- Surgery involved a modified maximal levator palpebrae superioris shortening technique.
- Preoperative and postoperative margin reflex distance 1 and levator muscle function were measured.
Main Results:
- Significant improvements in margin reflex distance 1 and levator function were observed (P < 0.01).
- A high success rate of 95.2% was achieved for eyelid height and symmetry.
- The technique demonstrated effectiveness even in patients with levator function ≤2 mm, though with a higher complication rate.
Conclusions:
- Modified maximal levator palpebrae superioris shortening is an effective and durable treatment for severe congenital ptosis.
- The method is suitable for patients with poor levator muscle function, including those with function ≤2 mm.
- While effective, potential complications like overcorrection and eyelid fold deformity require consideration.
Objective:
This study aims to evaluate the clinical effect of modified maximal levator palpebrae superioris shortening method for severe congenital ptosis.
Methods:
A retrospective case series was performed including 66 eyes from 62 patients who underwent modified maximal levator palpebrae superioris shortening surgery to treat severe congenital ptosis between February 2015 and November 2018. Preoperative and postoperative margin reflex distance 1 and levator muscle function were recorded. The surgical results were graded as good, satisfied, and poor for functional and cosmetic improvement of the eyelids, and the incidence of complications was also documented.
Results:
The mean patient age at the time of surgery was 4.6 ± 1.8 years (2-9 years), and the mean follow-up time was 36.3 ± 14.1 (12-55 months). A mean significant improvement in margin reflex distance 1 and levator function after operation was noted (P < 0.01). The eyelid height and symmetry were satisfied in 59 patients, with success rate of 95.2%. For the patients in the levator function (≤2 mm) group, the success rate was 87.5%. Moreover, the levator function (≤2 mm) group had a higher rate of poor results than levator function (2-4 mm) group (12.5% vs 2.2%). Overcorrection (6.5%) and eyelid fold deformity (11.3%) were the most frequent postoperative complications.
Conclusion:
Modified maximal levator palpebrae superioris shortening was effective and endurable in the treatment of severe congenital ptosis with poor levator function, including in patients whose levator function was less than 2 mm.
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