Efficacy of Combined Conjoint Fascial Sheath and Levator Muscle Composite Flap Suspension for Recurrent Severe Ptosis

Conjoint fascial sheath (CFS) and levator muscle (LM) composite flap suspension has been gradually accepted for the treatment of congenital severe blepharoptosis in recent years. This study is to evaluate the clinical efficacy of conjoint fascial sheath with levator muscle (CFS + LM) suspension in the treatment of recurrent severe ptosis.

A total of 45 patients (51 eyes) with recurrent severe ptosis admitted to our hospital between February 2018 and October 2022 were treated with CFS + LM suspension. The surgical efficacy was evaluated by recording and analyzing the distance (in millimeters) from the pupillary reflex on the patient's cornea to the upper eyelid margin (MRD1), palpebral fissure height (PFH), lagophthalmos (LAG), degree of satisfaction and complications.

A total of 45 patients (51 eyes) with recurrent severe ptosis were included in this study, including 26 males and 19 females, with an average age of 23.16 ± 10.68 years. The average levator function was 1.98 ± 1.35 mm, and the average postoperative follow-up time was 19.71 ± 13.77 month. The preoperative MRD1 and PFH were - 0.18 ± 1.03 mm and 3.90 ± 0.88 mm, respectively. Postoperative follow-up was conducted at least 6 months, and the MRD1 and PFH values were 2.25 ± 0.77 mm and 7.04 ± 0.82 mm at the last follow-up, respectively; the differences with the corresponding preoperative values were significant (p< 0.05). All the operated eyes had different degrees of LAG, which also stabilized 6 months after surgery. The treatment was considered curative for 30 eyes (58.82%), to have made improvement in 11 eyes (21.57%), and ineffective for 10 eyes (19.61%). The overall effectiveness (curative + improvement) rate was 80.39%, and the total degree of satisfaction reached 77.78%. After surgery, conjunctival prolapse occurred in 3 patients, 2 of whom recovered after placement of fornix sutures. Conjunctival prolapse in 1 patient disappeared after conservative treatment. Exposure keratitis occurred in 1 patient and improved after drug treatment. No other complications occurred.

CFS + LM suspension technique for correcting recurrent severe ptosis is easy to perform, causes minimal trauma, and results in good therapeutic effects and few complications. We recommend popularizing this technique in clinical practice.

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