Ju-Hyang Lee1,2, Orapan Aryasit3, Yoon-Duck Kim4, Kyung In Woo4, Llewellyn Lee5, Owen N Johnson6. 1. Department of Ophthalmology, Ulsan University Hospital, Ulsan University School of Medicine, Ulsan, Korea. 2. Department of Ophthalmology, Hanyang University Graduate School of Medicine, Seoul, South Korea. 3. Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. 4. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 5. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore. 6. Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
Abstract
BACKGROUND/AIMS: Surgical treatments for the correction of congenital ptosis with poor levator function, including frontalis suspension or maximal levator resection, remain controversial. We evaluated the postoperative surgical and cosmetic outcomes after maximal levator resection for unilateral congenital ptosis with poor levator function. METHODS: A retrospective, interventional case series was performed. A total of 243 patients with 243 eyelids (210 unilateral and 33 bilateral asymmetric ptosis) who underwent unilateral maximal levator resection were included. The surgical results were graded as excellent, good and poor and postoperative complications were documented. RESULTS: The mean age at the time of surgery was 8.8±9.7 years (range, 2-58 years) with mean follow-up time of 40.9±38.9 months (range, 3 months to 18.9 years). Satisfactory results (excellent or good result) were obtained in 93.0% of the patients. Patients were divided into two groups based on levator function as follows: 0-2 mm (80 cases) and 2.5-4.0 mm (163 cases). Factors such as preoperative levator function, margin reflex distance-1 and levator dehiscence were not correlated with postoperative surgical outcomes. Complications included exposure keratopathy (11.1%), lid crease asymmetry (8.2%), entropion (8.2%), overcorrection (3.3%), eyelash ptosis (3.7%), temporal eyelid droop (3.3%), suture abscess (0.8%) and conjunctival prolapse (0.8%). CONCLUSIONS: Maximal levator resection is an effective procedure for congenital ptosis even in patients with poor levator function, which provides improved cosmesis, a more natural lid contour, and avoids brow scars. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND/AIMS: Surgical treatments for the correction of congenital ptosis with poor levator function, including frontalis suspension or maximal levator resection, remain controversial. We evaluated the postoperative surgical and cosmetic outcomes after maximal levator resection for unilateral congenital ptosis with poor levator function. METHODS: A retrospective, interventional case series was performed. A total of 243 patients with 243 eyelids (210 unilateral and 33 bilateral asymmetric ptosis) who underwent unilateral maximal levator resection were included. The surgical results were graded as excellent, good and poor and postoperative complications were documented. RESULTS: The mean age at the time of surgery was 8.8±9.7 years (range, 2-58 years) with mean follow-up time of 40.9±38.9 months (range, 3 months to 18.9 years). Satisfactory results (excellent or good result) were obtained in 93.0% of the patients. Patients were divided into two groups based on levator function as follows: 0-2 mm (80 cases) and 2.5-4.0 mm (163 cases). Factors such as preoperative levator function, margin reflex distance-1 and levator dehiscence were not correlated with postoperative surgical outcomes. Complications included exposure keratopathy (11.1%), lid crease asymmetry (8.2%), entropion (8.2%), overcorrection (3.3%), eyelash ptosis (3.7%), temporal eyelid droop (3.3%), suture abscess (0.8%) and conjunctival prolapse (0.8%). CONCLUSIONS: Maximal levator resection is an effective procedure for congenital ptosis even in patients with poor levator function, which provides improved cosmesis, a more natural lid contour, and avoids brow scars. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Entities:
Keywords:
Child health (paediatrics); Cosmesis; Eye Lids; Treatment Surgery
Authors: Antonio A V Cruz; Stefania B Diniz; Juliana A Guimarães; Roque L Souza; Alicia Galindo-Ferreiro; Lilyan M F Araujo; Sheila A P Cecchetti; Ana Estela B SanťAnna Journal: Int Ophthalmol Date: 2022-08-29 Impact factor: 2.029