Skip to main content

Advertisement

SpringerLink
Log in

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

  • Oculoplastics and Orbit
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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.S111118

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. 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/10.3928/0191-3913-20020701-10

    Article  PubMed  Google Scholar 

  3. 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.0b013e31818ab497

    Article  PubMed  Google Scholar 

  4. 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/s41598-018-26671-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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.2001.118215

    Article  CAS  Google Scholar 

  6. 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.2012.09.010

    Article  PubMed  Google Scholar 

  7. 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.0000000000001284

    Article  PubMed  Google Scholar 

  8. 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.2020.11.16

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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/10.1080/08820538.2017.1297840

    Article  PubMed  Google Scholar 

  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)00466-5

    Article  PubMed  Google Scholar 

  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.2005.05.031

    Article  PubMed  Google Scholar 

  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.2012.10.022

    Article  PubMed  Google Scholar 

  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.0160827

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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.2012.12.015

    Article  PubMed  PubMed Central  Google Scholar 

  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.2014.04.001

    Article  PubMed  PubMed Central  Google Scholar 

  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.v8i1.16154

    Article  PubMed  Google Scholar 

  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/s12886-016-0351-9

    Article  PubMed  PubMed Central  Google Scholar 

  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)90011-2

    Article  CAS  PubMed  Google Scholar 

  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/10.3928/0191-3913-19920301-06

    Article  CAS  PubMed  Google Scholar 

  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.0000000000000729

    Article  PubMed  Google Scholar 

  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.S264732

    Article  PubMed  PubMed Central  Google Scholar 

  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_20

    Article  PubMed  PubMed Central  Google Scholar 

  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/10.1097/00002341-199805000-00001

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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.86.11.1282

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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/10.1080/01676830.2017.1337179

    Article  PubMed  Google Scholar 

  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_21

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Google Scholar 

  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-2016-309163

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel

    Ortal Fogel Tempelhof, Anat Bachar Zipori, Daphna Mezad-Koursh, Muhammad Abumanhal, Igal Leibovitch & Ran Ben Cnaan

  2. Department of Radiology, Shamir, Assaf Harofeh Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Be’er Ya’akov, Israel

    Elena Tomashpolski

Authors
  1. Ortal Fogel Tempelhof
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anat Bachar Zipori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daphna Mezad-Koursh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elena Tomashpolski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Muhammad Abumanhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Igal Leibovitch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ran Ben Cnaan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed for the interpretation of data, critical revising of drafts, approval of final version, and agree to be accountable for all aspects of the work and its integrity. RBC, ABZ and OFT are responsible for the conception and design of the study. OFT and ET were responsible for medical data extraction and analysis.

Corresponding author

Correspondence to Ortal Fogel Tempelhof.

Ethics declarations

Ethics approval

This longitudinal cohort study was approved by the Institutional Review Board (IRB) of The Tel Aviv Medical Center and performed in accordance with the declaration of Helsinki.

Conflict of interest

The authors declare no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fogel Tempelhof, O., Bachar Zipori, A., Mezad-Koursh, D. et al. Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery. Graefes Arch Clin Exp Ophthalmol 261, 2979–2986 (2023). https://doi.org/10.1007/s00417-023-06105-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-023-06105-1

Keywords

Search

Navigation