Surgical Outcome of Levator Resection in Congenital Ptosis with Poor Levator Function at a Tertiary Care Centre

Abstract

Introduction: Treatment of congenital ptosis is challenging as results are unpredictable. The ideal surgical technique which gives optimal cosmetic outcome without complications is still evolving. Tarso-frontalis sling operation is the preferred standard of care when levator action is poor but it has high rate of complications. Hence, supramaximal levator resection has been advocated over the past two decades as an alternative treatment modality. Aim: To assess the effectiveness of supramaximal levator resection in patients with unilateral simple congenital ptosis, having poor levator action (≤4 mm). Materials and Methods: A longitudinal interventional study was conducted over a period of six months. Fifteen patients, during the study period, underwent supramaximal levator resection under General Anesthesia (GA) after taking informed consent from next of kin. All patients were evaluated on day one, one week, one, three and six months after surgery. Surgical outcome measures were change in margin reflex distance-1, vertical palpebral fissure height and inter-eyelid difference of margin reflex distance. Success was defined as margin reflex distance-1 (MRD-1) ≥3 mm and inter-eyelid difference of MRD-1 between 0.5 and 1 mm. Results: There were 10 females (60%) and 5 males (40%) in the study group. The mean age group at the time of ptosis surgery was 5.73±0.55 years (range from 03 and 11 years). A good surgical outcome was obtained in 12 (80%) patients. In 02 (13.3%) patients under-correction was noted which did not need further intervention as visual axis was clear. Upper lid swelling occurred in one patient (6.6%) which was treated with anti-inflammatory medications. Conclusion: Supramaximal levator resection may be considered in all cases of unilateral ptosis patients with poor levator action as this procedure yields good surgical outcomes.