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Manejo Quirúrgico de la Ptosis Congénita Severa: Una Revisión Sistemática
Hanyi Jiang1, Zhiwei Chen2, Yilue Zheng1
1Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences.
Objective:
Severe congenital ptosis, primarily caused by levator palpebrae superioris (LPS) underdevelopment, may impair visual development and facial aesthetics. Although multiple surgical techniques exist, optimal procedure selection and long-term outcomes remain debated.
Methods:
A systematic review was conducted following PRISMA guidelines. The authors searched PubMed, ScienceDirect, and Google Scholar for English-language studies (2014-2024) on severe congenital ptosis (MRD1 <1 mm, LPS function ≤4 mm). Inclusion criteria encompassed primary surgical intervention, detailed technique description, and ≥6 months of follow-up. Studies of acquired ptosis or syndromic cases were excluded. Two reviewers independently performed screening, data extraction, and quality assessment.
Results:
Fourteen studies were included. Three core surgical approaches were identified: (1) frontalis suspension, (2) levator resection, and (3) conjoint fascial sheath-levator complex fixation (CFS+LM). Outcomes varied by patient age, LPS function, and anatomical maturity.
Conclusions:
Surgical management of severe congenital ptosis should be individualized. Based on the evidence, a decision-making algorithm was developed incorporating patient age and LPS function. Frontalis suspension remains the preferred option for markedly impaired LPS function, whereas levator resection and CFS-based techniques are viable alternatives when anatomical conditions allow. Prospective studies with standardized outcome measures are needed to confirm long-term effectiveness.
Level Of Evidence:
Level III.
