Levator Muscle Complex Exploration During Surgery for Simple Severe Congenital Ptosis

Area of Science:

• Ophthalmology
• Surgical Anatomy
• Congenital Ptosis Research

Background:

• Severe congenital ptosis with poor levator function (LF) presents surgical challenges.
• Traditional surgical planning relies on preoperative LF measurements.
• The gross morphology of the levator palpebrae superioris (LPS) muscle complex in these cases requires detailed description.

Purpose of the Study:

• To describe the gross morphology of the LPS muscle complex in severe congenital ptosis with poor LF.
• To evaluate surgical outcomes of levator surgery guided by intraoperative LPS muscle findings.

Main Methods:

• Retrospective, interventional case series of children with simple severe congenital ptosis and LF ≤ 4 mm.
• Intraoperative evaluation of LPS muscle morphology, including fatty infiltration grading.
• Surgical planning adjusted based on intraoperative LPS assessment, rather than solely preoperative LF.

Main Results:

• 109 eyelids analyzed; levator aponeurosis was thin in 56.9% and thick with fibrosis in 43.1%.
• Distal LPS muscle showed fatty infiltration and abnormal vessels in all cases.
• Proximal LPS zone (fleshy red) in 71.6% allowed successful tarsal plate attachment, significantly improving margin reflex distance 1 and LF (p < 0.001).

Conclusions:

• Intraoperative LPS muscle assessment is crucial for surgical planning in severe congenital ptosis.
• Levator-based surgery, when indicated by intraoperative findings, yields successful outcomes.
• This approach allows for a shift from frontalis suspension to levator surgery, enhancing functional results.