Surgical Timing Before Age 3 for Congenital Ptosis: Enhancing Refractive Parameters Recovery in Children

The aim of this study is to evaluate the impact of congenital ptosis on visual development and observe postoperative refractive parameters recovery patterns between two distinct age groups: children under 3 years and preschool-aged children (3-6 years).

A cohort study was conducted among 77 patients aged 1 to 6 years diagnosed with severe unilateral congenital simple ptosis at our hospital. Key data points included demographic data, marginal reflex distance 1 (MRD1), refractive status, and best-corrected visual acuity (BCVA). Preoperative refractive data and ocular examination results were compared with corresponding postoperative data.

The prevalence of pathological anisometropia preoperatively was 26.9% for toddlers and 20% for preschoolers. There was a significant difference in preoperative cylinder power between the affected and unaffected eyes (P < 0.01). Among patients aged under 3 years, postoperative difference in spherical equivalent (△SE) showed significant improvement compared to preoperative △SE (P < 0.05). Among patients older than 3 years, there was no significant change in △SE or BCVA. Both age groups showed no significant change in cylinder power.

Severe unilateral congenital ptosis induces pathological anisometropia and astigmatism while depleting hyperopic reserve in pediatric patients. Early surgical intervention before age 3 years effectively enhances the recovery of refractive parameters. The evidence substantiates the requirement for timely surgical correction during the visual system's critical developmental period.

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