Postoperative outcomes in mitochondrial myopathy-associated ptosis: a case series

To determine the anatomical and functional success and complication rates after surgical treatment in cases of mitochondrial myopathy (MM) with ptosis and how the complications that develop may be managed.

Patients who underwent surgical correction due to ptosis between October 2010 and January 2020 and diagnosed with MM on muscle biopsy were retrospectively analyzed. The margin reflex distance 1 (MRD1) values of the patients were evaluated preoperatively, postoperative 1st week, 1st month, 6th month and 12th month. The complications that developed during the follow-ups and their management were examined.

The study included 64 eyes of 34 patients. In all patients, the MRD1 value at 1 week, 1 month, 6 months, and 12 months after the surgery showed a significant increase compared to the preoperative value (p < 0.05). Lagophthalmic keratitis developed in 1 eye (1.56%) that underwent levator resection and healed without sequelae. In 1 eye (1.56%) that underwent silicone frontal sling, lagophthalmic keratitis and inferior corneal ulcer developed, healed with minimal corneal haze and did not affect visual acuity. A corneal ulcer developed in 1 eye (1.56%) that underwent levator resection 12 months later due to insufficient lubricant treatment and healed with minimal corneal haze without causing vision loss with frequent topical lubricant and topical antibiotics. One of the two patients who underwent levator resection had ptosis progression in one eye after 18 months and the other in one eye after 24 months. Surgical revision was not required.

Complications related to lagophthalmos may be prevented with the appropriate patient and surgical method selection and frequent postoperative observation. Early intervention in developing complications may also prevent serious complications that cause visual sequelae.