Surgical Management of Congenital and Aponeurotic Ptosis – Cosmetic Outcome

Research Article

Austin J Clin Ophthalmol. 2014;1(7): 1035.

Surgical Management of Congenital and Aponeurotic Ptosis – Cosmetic Outcome

Rizvi SAR*, Yousuf S and Gupta Y

Institute of Ophthalmology, Jawaharlal Nehru Medical College, India

*Corresponding author: Rizvi SAR Ophthalmic Plastic Surgery and Ocular Oncology Services, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, UP, 202002. India

Received: August 20, 2014; Accepted: September 18, 2014; Published: September 20, 2014

Abstract

To determine the cosmetic results following the surgical correction of congenital and acquired ptosis. A retrospective review of the surgical outcome of 64 eyes of 57 cases of congenital and acquired ptosis operated by single surgeon between January 2009 and December 2013 was evaluated. 21 cases (23 eyes) underwent a levator resection procedure, 23 cases (28 eyes) were operated by frontalis suspension using silicone rod, 6 cases (9 eyes) were operated by levator advancement procedure for aponeurotic ptosis and 4 cases were corrected by fasanella servant surgery and 3 cases by mullerectomy. Cosmetic outcome were considered to be good if post operative symmetry between two eyelids is ≤1mm,fair if symmetry is between 1.5 -2.0 mm and poor if it is >2mm at 6 weeks of follow up. Out of total 57 cases, a good cosmetic result was achieved in 45 cases (79%), fair in 7 cases (12%) and poor result was seen in 5 cases (9%). An acceptable cosmetic result was achieved in 91% of all cases. In 9% of cases with poor cosmesis, re surgery was required. Regular follow-ups will help in adequate management of complications and recurrence of ptosis.

Keywords: Congenital; Acquired; Ptosis; Surgery; Cosmesis

Introduction

Ptosis is defined as an abnormal low lying upper eyelid margin with eyes in primary gaze [1]. Ptosis is considered congenital if present at birth or within the first year of life [2]. The most common cause of congenital ptosis is localized myogenic dystrophy of levator palpebrae superioris. Few cases of congenital ptosis result from genetic or chromosomal defects or neurological dysfunction [3]. Simple congenital ptosis with normal superior rectus function is seen in 95% cases. Congenital ptosis can be associated with blepharophimosis syndrome (5%) and synkinetic ptosis (5%) which includes Marcus Gunn jaw winking ptosis and misdirected third nerve ptosis. In patients with congenital ptosis reduced levator function, absent lid crease and lid lag are characteristic findings. Acquired ptosis is classified into Neurogenic, Myogenic, Aponeurotic and Mechanical Ptosis. Majority of cases are due to aponeurotic causes such as involutional changes, disinsertion or dehiscence. In aponeurotic cases, the lid crease is higher due to disinsertion of the posterior aponeurotic attachment to the tarsus.

Material and Methods

A retrospective analysis was made of all 64 eyes (57 cases) of surgically corrected congenital ptosis operated by single surgeon between January 2009- December 2013. Cosmetic outcome was determined by post operative eyelid symmetry at 6 weeks of follow-up. It was graded as good if ≤1mm; fair if between 1.5 -2.0 mm and poor if >2mm.

Surgical procedures

Fifty-one cases were operated for congenital ptosis by four surgical techniques. The mean follow-up period was six weeks. Twenty-one patients underwent levator resection procedure. Two patients had bilateral procedures for bilateral ptosis giving a total of twenty-three procedures. Twenty-three patients underwent frontalis suspension using silicone rod. Five of the patients had bilateral procedures for bilateral ptosis giving a total of twenty-eight procedures. Four patients underwent Fasanella Servat procedure and three patients underwent mullerectomy. Six cases were operated for aponeurotic ptosis with levator advancement procedure.

Results

In all the 51 patients of congenital ptosis, ptosis was recognised since birth. All the patients had decreased levator function, absent lid crease and lid lag in down gaze.

In 21 cases of levator resection, 16(76%) cases (1 bilateral) achieved good cosmetic results (Figure 1a,1b), 3(14%) cases (1 bilateral) showed fair result and 2 (10%) cases had poor surgical outcome. The two patients (2 eyes) who showed poor cosmetic result were young children and poor result may be attributed to improper preoperative evaluation. (Figure 2).