Paediatric blepharoptosis: a 10-year review

Abstract

Purpose To examine the characteristics of blepharoptosis and the success of surgical intervention in a large group of children presenting to a specialist at paediatric ophthalmology center. Methods Ten-year retrospective case notes review of patients presenting to the Birmingham Children's Hospital for blepharoptosis surgery. Resultant database was interrogated for aetiology of ptosis; severity; surgical correction; outcome; complications and need for reoperation. Results One hundred and fifty five children (186 eyes) underwent blepharoptosis surgery. Hundred and ten patients (71%) were treated with a levator resection procedure, 28 (18%) underwent a brow suspension using Mersilene mesh, 15 (10%) with Fasanella Servat procedure and 2 (1%) with La Mange procedure. The mean post-operative follow-up was 30.82 months with 84 children completing a minimum of 12 months follow-up. Overall, 70.97% lids were successfully corrected with a single operation. In 9.14% lids, the results were fair but no further surgery was carried out. Reoperation was required in 19.89% of lids with the mean time to second surgery being 32.69 months. Amblyopia was found in 26.45% (41 children); in 3 patients, their amblyopia became manifest after the ptosis surgery. A concomitant squint was present in 14.19%, and 18.70% had a significant refractive error requiring spectacles prescription, with anisometropia present in more than 72% of these patients. Conclusions Early referral to an ophthalmologist is necessary even though surgical correction may be delayed. Children with congenital ptosis need to be monitored for amblyopia both pre-and post-operatively, as the incidence of strabismus and refractive errors is much higher than the general population and these may develop even after ptosis surgery.

Maximal Levator Muscle Resection for Primary Congenital Blepharoptosis with Poor Levator Function

“…1,2 Frontalis suspension is the most commonly used surgical technique for the correction of severe congenital ptosis with poor levator muscle function ( 4 mm). 3,4 Various surgical designs and different suspension materials have been described and autogenous fascia lata has been considered the goldstandard material. Despite the fact that recent studies showed successful results with frontalis suspension surgery, numerous other studies reported the disadvantages and complications of this surgery.…”

Evaluation of Surgical Outcomes in Patients with Blepharoptosis

“…22 Frontal askı tekniği, levator fonksiyonunun yetersiz olduğu ağır pitozis olgularında, nöromus-küler hastalıklara bağlı pitozislerde, blefarofimozis sendromlu olgularda yaygın olarak kullanılan bir tekniktir. 7 Frontal askı cerrahisinde çok çeşitli askı materyalleri kullanılmakla birlikte ideal askı materyeli konusunda tam bir görüş birliği yoktur. Fasiya lata, kozmetik olarak en iyi sonuç veren, en az komplikasyon ve en az nüks oranı elde edilen askı materyali olarak bildirilmektedir.…”

“…6 Levator cerrahisi ile hem konjenital hem de edinsel pitozis olgularında başarılı sonuçlar bildirilmiştir. [7][8][9] Levator fonksiyonun yetersiz olduğu blefaropitozis olgularında organik veya inorganik maddeler ile frontal askı cerrahisi uygulanmaktadır. Günümüzde askı materyali olarak otojen fasiya lata, donör fasiya latası, ayak ekstansör tendonu, palmaris longus tendonu, poliflament naylon kablo tip sütür, polipropilen, mersilen "mesh", silikon, politetrafluoroetilen gibi maddeler tercih edilmektedir.…”

“…Frontal askılama, konjenital miyojenik pitozislerde sıklıkla tercih edilmekle birlikte blefarofimozis sendromu, 3. sinir felçleri ve MarcusGunn çene göz kırpma fenomeninde de uygulanmaktadır. 7,10,11 Çalışmamızda, kliniğimizde levator aponevroz cerrahisi veya frontal askı cerrahisi uyguladığımız konjenital ve edinsel blefaropitozis olgularının cerrahi sonuçlarının değerlendirilmesi amaçlanmıştır.…”

The association of refractive error, strabismus, and amblyopia with congenital ptosis

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Harrad and colleagues 2 identified amblyopia in only 17% of children with ptosis. On the other hand, Fiergang and colleagues 1 found amblyopia in 71% of patients with unilateral or asymmetric congenital ptosis severe enough to cause compensatory head posturing; they attributed the amblyopia to deprivation from the ptosis in 80% of amblyopic children.…”