Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Published in:

17-05-2023 | Ptosis | Oculoplastics and Orbit

Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery

Authors: Ortal Fogel Tempelhof, Anat Bachar Zipori, Daphna Mezad-Koursh, Elena Tomashpolski, Muhammad Abumanhal, Igal Leibovitch, Ran Ben Cnaan

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 10/2023

Abstract

Purpose

Comparing the surgical and refractive outcomes of congenital ptosis repair by different surgical techniques.

Methods

This longitudinal cohort study reviewed medical records of 101 patients who underwent congenital ptosis repair, from 2006 to 2022 in a single center. Analysis was performed for demographic background, co-morbidities, pre-operative and post-operative ocular examinations and refraction, complications, reoperations, and success rates.

Results

Following exclusion criteria, we remained with 80 patients (103 eyes) who underwent either frontalis muscle suspension surgery (FMS) (55 eyes) or levator muscle surgery (LM) (48 eyes). Patients in the FMS group were younger (mean age of 3.1 vs. 6.0 years, p < 0.001) and had worse pre-operative ocular assessments including prevalence of visual axis involvement, chin-up head position, ptosis severity, and levator muscle function (LF) (p < 0.001). Both groups had a 25% rate of reoperation, however while in the LM group reoperation was required solely due to undercorrection, in the FMS group various indications prompted reoperation. Success rate was higher in the FMS group (87.3% vs. 60.4%, p = 0.002). While pre-operative astigmatism was higher in the LM group (p = 0.019), no significant differences were observed post-operatively. Spherical and spherical equivalent changes over time were significant only in the FMS group (p = 0.010 and p = 0.004, respectively).

Conclusions

Within our cohort, a higher success rate of congenital ptosis repair was observed among patients who underwent FMS compared to LM, despite similar reoperation rates. In cases of severe ptosis and moderate LF, LM demonstrated a lower-than-anticipated success rate. Astigmatic changes following ptosis repair were not consistent in either group.

Marenco M, Macchi I, Macchi I et al (2017) Clinical presentation and management of congenital ptosis. Clin Ophthalmol 11:453–463. https://doi.org/10.2147/OPTH.S111118CrossRefPubMedPubMedCentral

Dray J-P, Leibovitch I (2002) Congenital ptosis and amblyopia: a retrospective study of 130 cases. J Pediatr Ophthalmol Strabismus 39:222–225. https://doi.org/10.3928/0191-3913-20020701-10CrossRefPubMed

Lin LK, Uzcategui N, Chang EL (2008) Effect of surgical correction of congenital ptosis on amblyopia. Ophthal Plast Reconstr Surg 24:434–436. https://doi.org/10.1097/IOP.0b013e31818ab497CrossRefPubMed

Wang Y, Xu Y, Liu X et al (2018) Amblyopia, strabismus and refractive errors in congenital ptosis: a systematic review and meta-analysis. Sci Rep 8:8320. https://doi.org/10.1038/s41598-018-26671-3CrossRefPubMedPubMedCentral

Klimek DL, Summers CG, Letson RD, Davitt BV (2001) Change in refractive error after unilateral levator resection for congenital ptosis. J Am Assoc Pediatr Ophthalmol Strabismus 5:297–300. https://doi.org/10.1067/mpa.2001.118215CrossRef

Skaat A, Fabian ID, Spierer A et al (2013) Congenital ptosis repair—surgical, cosmetic, and functional outcome: a report of 162 cases. Can J Ophthalmol 48:93–98. https://doi.org/10.1016/j.jcjo.2012.09.010CrossRefPubMed

Chisholm SAM, Costakos DM, Harris GJ (2019) Surgical timing for congenital ptosis should not be determined solely by the presence of anisometropia. Ophthal Plast Reconstr Surg 35:374–377. https://doi.org/10.1097/IOP.0000000000001284CrossRefPubMed

Zeng X-Y (2020) Effects of congenital ptosis on the refractive development of eye and vision in children. Int J Ophthalmol 13:1788–1793. https://doi.org/10.18240/ijo.2020.11.16CrossRefPubMedPubMedCentral

Gazzola R, Piozzi E, Vaienti L, Wilhelm BaruffaldiPreis F (2018) Therapeutic algorithm for congenital ptosis repair with levator resection and frontalis suspension: results and literature review. Semin Ophthalmol 33:454–460. https://doi.org/10.1080/08820538.2017.1297840CrossRefPubMed

10.

Leibovitch I, Leibovitch L, Dray J-P (2003) Long-term results of frontalis suspension using autogenous fascia lata for congenital ptosis in children under 3 years of age. Am J Ophthalmol 136:866–871. https://doi.org/10.1016/S0002-9394(03)00466-5CrossRefPubMed

11.

Ben Simon GJ, MacEdo AA, Schwarcz RM et al (2005) Frontalis suspension for upper eyelid ptosis: evaluation of different surgical designs and suture material. Am J Ophthalmol 140:877–885. https://doi.org/10.1016/j.ajo.2005.05.031CrossRefPubMed

12.

Hayashi K, Katori N, Kasai K et al (2013) Comparison of nylon monofilament suture and polytetrafluoroethylene sheet for frontalis suspension surgery in eyes with congenital ptosis. Am J Ophthalmol 155:654-663.e1. https://doi.org/10.1016/j.ajo.2012.10.022CrossRefPubMed

13.

Pacella E, Mipatrini D, Pacella F et al (2016) Suspensory materials for surgery of blepharoptosis: a systematic review of observational studies. PLOS ONE 11:e0160827. https://doi.org/10.1371/journal.pone.0160827CrossRefPubMedPubMedCentral

14.

Holladay JT (2004) Visual acuity measurements. J Cataract Refract Surg 30:287–290. https://doi.org/10.1016/j.jcrs.2004.01.014CrossRefPubMed

15.

Berry-Brincat A, Willshaw H (2009) Paediatric blepharoptosis: a 10-year review. Eye 23:1554–1559. https://doi.org/10.1038/eye.2008.311CrossRefPubMed

16.

Griepentrog GJ, Diehl N, Mohney BG (2013) Amblyopia in childhood eyelid ptosis. Am J Ophthalmol 155:1125-1128.e1. https://doi.org/10.1016/j.ajo.2012.12.015CrossRefPubMedPubMedCentral

17.

Griepentrog GJ, Mohney BG (2014) Strabismus in childhood eyelid ptosis. Am J Ophthalmol 158:208-210.e1. https://doi.org/10.1016/j.ajo.2014.04.001CrossRefPubMedPubMedCentral

18.

Gautam P, Adhikari R, Sharma BR (2016) Etiopathogenetic patterns of blepharoptosis in Western Nepal : an overview. Nepal J Ophthalmol 8:36–40. https://doi.org/10.3126/nepjoph.v8i1.16154CrossRefPubMed

19.

Paik J-S, Kim S-A, Park SH, Yang S-W (2016) Refractive error characteristics in patients with congenital blepharoptosis before and after ptosis repair surgery. BMC Ophthalmol 16:177. https://doi.org/10.1186/s12886-016-0351-9CrossRefPubMedPubMedCentral

20.

Merriam WW, Ellis RD, Helveston EM (1980) Congenital blepharoptosis, anisometropia, and amblyopia. Am J Ophthalmol 89:401–407. https://doi.org/10.1016/0002-9394(80)90011-2CrossRefPubMed

21.

Cadera W, Orton R, Hakim O (1992) Changes in astigmatism after surgery for congenital ptosis. J Pediatr Ophthalmol Strabismus 29:85–88. https://doi.org/10.3928/0191-3913-19920301-06CrossRefPubMed

22.

Savino G, Battendieri R, Riso M et al (2016) Corneal topographic changes after eyelid ptosis surgery. Cornea 35:501–505. https://doi.org/10.1097/ICO.0000000000000729CrossRefPubMed

23.

Gandhi A, Mehta A, Naik M (2020) Does frontalis sling surgery for congenital ptosis change the corneal topography and refractive characteristics postoperatively? Clin Ophthalmol 14:3667–3673. https://doi.org/10.2147/OPTH.S264732CrossRefPubMedPubMedCentral

24.

Assadi F, Narayana S, Yadalla D et al (2021) Effect of congenital ptosis correction on corneal topography- A prospective study. Indian J Ophthalmol 69:1527. https://doi.org/10.4103/ijo.IJO_2650_20CrossRefPubMedPubMedCentral

25.

Holck DEE, Dutton JJ, Wehrly SR (1998) Changes in astigmatism after ptosis surgery measured by corneal topography. Ophthal Plast Reconstr Surg 14:151–158. https://doi.org/10.1097/00002341-199805000-00001CrossRefPubMed

26.

Cates CA, Tyers AG (2001) Outcomes of anterior levator resection in congenital blepharoptosis. Eye 15:770–773. https://doi.org/10.1038/eye.2001.247CrossRefPubMed

27.

Lee V, Konrad H, Bunce C et al (2002) Aetiology and surgical treatment of childhood blepharoptosis. Br J Ophthalmol 86:1282–1286. https://doi.org/10.1136/bjo.86.11.1282CrossRefPubMedPubMedCentral

28.

Nguyen CT, Hardy TG (2017) Levator resection for congenital ptosis: Does pre-operative levator function or degree of ptosis affect successful outcome? Orbit 36:325–330. https://doi.org/10.1080/01676830.2017.1337179CrossRefPubMed

29.

Dawood AS, Hassan OA, El Sayed MO (2021) Maximal levator resection versus Gore-Tex® sling for congenital blepharoptosis with poor levator function. Oman J Ophthalmol 14:173–178. https://doi.org/10.4103/ojo.ojo_127_21CrossRefPubMedPubMedCentral

30.

Nabie R, Manouchehri V, Aminmozaffari S et al (2022) Levator muscle resection for simple congenital ptosis: its impact on preoperative levator function and dose-response ratio. Can J Ophthalmol S0008418222000138. https://doi.org/10.1016/j.jcjo.2022.01.008

31.

Kamal Z, McNab A (2001) Refinement of anterior levator resection algorithm for congenital ptosis. J Coll Physicians Surg Pak 11:639–641

32.

Lee J-H, Aryasit O, Kim Y-D et al (2017) Maximal levator resection in unilateral congenital ptosis with poor levator function. Br J Ophthalmol 101:740–746. https://doi.org/10.1136/bjophthalmol-2016-309163CrossRefPubMed

Title: Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery
Authors: Ortal Fogel Tempelhof
Anat Bachar Zipori
Daphna Mezad-Koursh
Elena Tomashpolski
Muhammad Abumanhal
Igal Leibovitch
Ran Ben Cnaan
Publication date: 17-05-2023
Publisher: Springer Berlin Heidelberg
Keyword: Ptosis
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 10/2023
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-023-06105-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2023

Severe anterior persistent fetal vasculature: the role of anterior retinal elongation on prognosis

Hyperreflective foci distribution in eyes with dry age-related macular degeneration with subretinal drusenoid deposits

PRESERFLO ™ MicroShunt versus trabeculectomy: 1-year results on efficacy and safety

Widefield oct-angiography-based classification of sickle cell retinopathy

Influence of isofocal intraocular lenses on objective refraction based on autorefraction and aberrometry

Remodeling of the choroidal vasculature and the role of choriocapillaris perfusion drop in pachychoroid diseases: a global rheological approach