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Son, Kim, Woo, and Park: Clinical Outcomes and Refractive Error Characteristics in Patients with Congenital Blepharoptosis after Ptosis Repair Surgery
Original Article

Journal of the Korean Ophthalmological Society 2019; 60(12): 1275-1283.

Published online: 17 December 2019

DOI: https://doi.org/10.3341/jkos.2019.60.12.1275

Clinical Outcomes and Refractive Error Characteristics in Patients with Congenital Blepharoptosis after Ptosis Repair Surgery

Ki Young Son, MD, Yoon-Duck Kim, MD, PhD, Kyung In Woo, MD, PhD, Kyung-Ah Park, MD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint requests to Kyung-Ah Park, MD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: 82-2-3410-3562, Fax: 82-2-3410-0074. lethe22@hanmail.net

Received 2 August 2019       Revised 30 September 2019       Accepted 6 December 2019

©2019 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated changes in postoperative refractive error after surgery to treat congenital ptosis and the clinical outcomes by surgical method.

Methods

The study was retrospective and interventional. We enrolled 73 patients in whom 86 eyes exhibited visual axis-obscuring congenital ptosis. All patients were under 8 years of age, with refractive errors or amblyopia, and underwent maximal levator resection or frontalis sling surgery with fascia lata preservation from January 2008 to January 2018; the minimum follow-up time was 6 months. Visual and surgical outcomes were assessed by reviewing clinical photographs taken before and 1 year after surgery. Refractive error changes were measured at these times.

Results

Maximal levator resection was performed on 42 of 86 eyes (48.8%) and frontalis sling surgery with preservation of the fascia lata on 44 eyes, 95.2% and 75.0% of patients, respectively, exhibited good or fair surgical outcomes. The preoperative mean astigmatisms of the ptotic and control eyes of those with unilateral disease did not differ significantly: −0.71 ± 0.85 D for ptotic eyes and −0.66 ± 0.97 D for control eyes. The mean astigmatism increased from −0.71 ± 0.85 D preoperatively to −1.27 ± 1.2 D postoperatively (p < 0.001). The postoperative MRD1 value correlated with the increase in postoperative astigmatism (p = 0.022, r = −0.261).

Conclusions

Maximal levator resection tended to afford better surgical outcomes than frontalis sling surgery with preservation of the fascia lata in patients with congenital ptosis. Patients in whom the postoperative eyelid position was good tended to exhibit higher refractive errors. Careful examination and treatment are recommended to ensure good visual outcomes.

Keywords: Astigmatism, Blepharoptosis, Congenital, Frontalis sling, Maximal levator resection

Figures and Tables

Figure 1

Postoperative astigmatism of patients divided into three groups: the highest (group 1), middle (group 2), and lowest (group 3) tertile of postoperative 1 year margin reflex distance 1 (MRD1). The patient group with the highest postoperative MRD1 tends to have higher astigmatism than the lowest one does (p = 0.005). D = diopters.

jkos-60-1275-g001
Table 1

Demographics of congenital ptosis patients

jkos-60-1275-i001

Values are presented as number (%).

PFL = preserved fascia lata.

Table 2

Clinical factors in ptotic eyes with versus without amblyopia

jkos-60-1275-i002

Values are presented as mean ± standard deviation or number (%).

PFL = preserved fascia lata.

*Mann-Whitney U test or t-test; †chi-square test or Fisher exact test.

Table 3

Surgical results of frontalis sling surgery versus maximal levator resection in congenital ptosis patients

jkos-60-1275-i003

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

PFL = preserved fascia lata; MRD1 = margin reflex distance 1.

*Mann-Whitney U test or t-test; †chi-square test or Fisher exact test.

Table 4

Multivariate logistic regression analysis of facters affecting surgical outcomes in congenital ptosis patients

jkos-60-1275-i004

The constant in the models is statiscally significant.

MRD = margin reflex distance.

*Logistic regression analysis.

Table 5

Astigmatism and its change after surgery in unilateral congenital ptosis patients

jkos-60-1275-i005

Values are presented as mean ± standard deviation.

D = diopters.

*p = 0.014; †Mann-Whitney U test or t-test.

Table 6

Astigmatism and its change in frontalis sling using PFL versus maximal levator resection patients

jkos-60-1275-i006

Values are presented as mean ± standard deviation.

PFL = preserved fascia lata; D = diopters.

*Mann-Whitney U test or t-test, p = 0.123; †Wilcoxon signed rank test or paired t-test.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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