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Modified levator muscle complex suspension on treating pediatric blepharoptosis with poor Bell's phenomenon
Rui Li1,2, Xiao-Wei Zhu1,2, Jia-Ying Zhang1,2
1Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhizaoju Road, Shanghai, 200011, China.
Insights
This study shows modified levator muscle complex suspension is effective for pediatric congenital blepharoptosis with poor Bell's phenomenon (BP). The procedure achieved high success rates, improved eyelid function, and had few complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital blepharoptosis can impair vision and is often associated with poor Bell's phenomenon (BP), a condition affecting eyelid closure during sleep.
- Surgical correction is necessary, but outcomes can be challenging in patients with poor BP due to increased risk of corneal exposure.
Purpose of the Study:
- To evaluate the surgical outcomes of pediatric congenital blepharoptosis with poor Bell's phenomenon (BP) treated with a modified levator muscle complex suspension technique.
- To assess the efficacy and safety of this modified surgical approach in improving eyelid function and protecting the ocular surface.
Main Methods:
- A retrospective review of 42 pediatric patients with congenital blepharoptosis and poor BP who underwent modified levator muscle complex suspension.
- Surgical outcomes including marginal reflex distance 1 (MRD1), palpebral fissure height (PFH), and postoperative lagophthalmos were analyzed.
- Follow-up averaged 10.28 months, assessing functional results and complications.
Main Results:
- Surgical success was achieved in 87.1% of eyelids, with 74.2% showing excellent results.
- Significant improvements were observed in PFH (from 3.58 mm to 7.97 mm) and MRD1 (from -1.48 mm to 2.94 mm).
- Postoperative lagophthalmos was mild (mean 1.42 mm at 3 months), and all patients achieved complete blink with no cases of exposure keratitis, though recurrence was noted in 12.9% of eyelids.
Conclusions:
- The modified levator muscle complex suspension is a safe and effective surgical option for pediatric congenital blepharoptosis with poor Bell's phenomenon.
- The technique facilitates complete blink, rapid recovery of lagophthalmos, and stable ocular surface with minimal complications.
- Its simplicity and low recurrence rate suggest it is suitable for wide application in this patient population.
Purpose:
To evaluate the surgical outcomes of pediatric congenital blepharoptosis with poor Bell's phenomenon (BP) treated with modified levator muscle complex suspension.
Methods:
Forty-two pediatric congenital blepharoptosis patients with poor BP were treated with modified levator muscle complex suspension, and their major surgical outcomes such as marginal reflex distance1 (MRD1), palpebral fissure height (PFH), and postoperative lagophthalmos were retrospectively reviewed.
Results:
The mean follow-up was 10.28 ± 9.89 months (range 3-32 Months). Surgical success was achieved in 54 (87.1%) of 62 eyelids at the final visit, including excellent results in 46 (74.2%) eyelids, good results in 8 (12.9%) eyelids, and poor results in 8 (12.9%) eyelids, respectively. The postoperative PFH of affected eyes (7.97 ± 1.47 mm) was significantly improved compared with that before surgery (3.58 ± 1.31 mm). The mean MRD1 was improved from - 1.48 ± 1.36 mm before surgery to 2.94 ± 1.46 mm after surgery. The postoperative MRD1 was ≥ 3 mm in 46 eyelids and < 3 mm in 16 eyelids. The mean lagophthalmos was 1.42 ± 1.20 mm 3 months after surgery. All of the patients presented complete blink postoperatively. Postoperative complications were rarely observed during follow-up. No patient had exposure keratitis, but blepharoptosis recurred in 6 patients (8 eyelids). All patients had satisfactory eyelid symmetry and contour. No complications were observed until the last visit.
Conclusions:
The modified method results complete blink, mild, and quick recovery of lagophthalmos, flexible eyelid motility, stable ocular surface, and it is simple to perform with few complications and a low recurrence rate at 12.9%, which is worth to wide application on poor Bell's phenomenon blepharoptosis.
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