Clinical and Demographic Characteristics of Blepharoptosis in Korea: A 24-year Experience including 2,328 Patients

Abstract

PurposeTo describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients.MethodsThis is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis.ResultsOf the 2,328 patients, 1,815 (78%) had congenital ptosis and 513 (22%) had acquired ptosis. Simple congenital ptosis is the most common type overall (73.7%), and aponeurotic ptosis is the most common acquired type. More than three-quarters of eyes with congenital ptosis were affected in a moderate (34.4%) to severe degree (41.3%), and most of these eyes had fair (33.7%) to poor LF (60.1%). Among eyes with acquired ptosis, approximately three-quarters were affected in a mild (33.3%) to moderate degree (41.0%), with 63.3% of these eyes having good LF. The most widely used surgical technique was frontalis suspension (55.1%), followed by levator resection (29.0%) and aponeurosis repair (14.8%). At 3 years after the first surgery, 15.7% of patients with congenital ptosis and 10.4% of patients with acquired ptosis underwent reoperation.ConclusionsAlthough the prevalence has decreased from previous years, the proportion of cases with congenital ptosis was higher in this study than has been shown in research conducted in the West. The majority of eyes with congenital ptosis was affected to a severe degree and had poor LF, while those with acquired ptosis were affected to a moderate degree and had good LF. More cases with acquired ptosis presented with fair to poor LF, and frontalis suspension surgery was performed more commonly compared to previous studies. The reoperation rate was higher in congenital ptosis compared to acquired ptosis.

Frequency and Associations of Marcus Gunn Phenomenon in Congenital Ptosis

“…Similar trends were observed in our study with 60% and 40% male and female distribution. Left sided congenital ptosis is reported more frequently in literature 7,9,12 . In our study, right sided congenital ptosis was more common.…”

“…Twnty three percent patients in our study had bilateral congenital ptosis. Bilateral congenital ptosis is reported about 3-7% in different reports 4,7,12 . In our study bilateral cases are reported in far major number.…”

“…Majority of the included patients (84%) had simple congenital ptosis. In a 24year report of blepharoptosis in Korea, simple congenital ptosis was reported to be the most common type of congenital ptosis overall with a frequency of 73.7% 12 . Gregory et al, also reported simple congenital ptosis as the most common type with 76% of the patients with childhood ptosis labelled as simple congenital ptosis 7 .…”

“…More than 90% patients in our study had moderate to severe ptosis. Severe ptosis is more common in case of congenital ptosis while in acquired ptosis mild-moderate ptosis severity is encountered more frequently 12 .…”

Eyelid reconstruction in ophthalmic surgical practice

“…Different studies report different prevalence of congenital and acquired ptosis. Lee et al, in their hospital-based study in Korea, found congenital ptosis in 78% of cases (4). In contrast, in Chicago, Lim et al, also in a hospital-based study, reported that the most common type of ptosis was aponeurotic ptosis (5).…”