Long-term refractive changes in children following ptosis surgery: a case series and a review of the literature

Abstract

The purpose of the study was to evaluate the long-term changes in refractive error in children with congenital ptosis managed with unilateral levator resection, and to provide a brief literature review and discuss the possible mechanisms for refractive change in the post-operative period. We present a retrospective consecutive case series of children (4-11 years old) who underwent unilateral levator resection, performed by a single ophthalmic surgeon to manage congenital ptosis between 1998 and 2001 at Maidstone Hospital, Kent. Cycloplegic refraction data were obtained prior to surgery and at the last clinic visit post surgery (minimum follow-up 12 months). The refractive changes in the non-operated contralateral eye were used as age-matched controls. Data were analysed for changes in refractive sphere and cylinder. Forty-three patients underwent levator resection during this 3-year period. Complete refraction data were available for 13 patients. The mean age at the time of levator resection was 6.7 years. The refractive error was greater on the side with the ptosis (61 %). At the last clinical follow up (mean 36.3 months; SD 34 months), the mean spherical change in the operated eye was 0.41D (range 0.12-1.50D), compared to a mean change of 0.40D (range 0.25-2.00D) in the non-operated eye. The mean cylindrical change in the operated eyes was 0.38D (range 0.25-1.00D), compared to a mean of 0.21D (range 0.50-1.75D) in the non-operated eye. In conclusion, this study did not show a significant change in refractive error following levator resection surgery for congenital ptosis.

Optical quality assessment in patients with unilateral congenital ptosis: a matched case-control study

“…The mechanisms of myopia in ptosis eyes are multifactorial and complicated. Form-deprivation by eyelid, defocused image on retinal and the eyelid pressure on eyeball might be the main causes [21][22][23]. Our results showed that there was no significant difference in refractive errors between the ptosis and the normal group, which was not in line with the literatures.…”

Amblyopia, Strabismus and Refractive Errors in Congenital Ptosis: a systematic review and meta-analysis

“… 35 proposed that in simple congenital ptosis the development of myopia and anisometropia might be due to the narrow palpebral aperture. Some studies suggested that the development of astigmatism in congenital ptosis was presumably due to eyelid tension and changes in the corneal curvature 5 , 25 , 40 , 41 . Ji-Sun P et al .…”

Corneal Topographic Changes After Eyelid Ptosis Surgeries Measured by Corneal Topography

“…Surgical repositioning of the eyelid increased pressure vectors on the cornea and the globe from above, thereby inducing with-the-rule astigmatism (i.e., corneal curvature greatest at the 90-degree axis) (Byard et al, 2014).…”