Surgical Treatment Of Severe Congenital Ptosis In Very Young Patients

ObjectiveTo investigate the clinical characteristics of congenital ptosis. To evaluate the effect of surgical treatment in very young patients with severe congenital ptosis.MethodsThe author performed a retrospective review of 10 patients aged 3 years or less who were treated by the Ophthalmic Center, Second Affiliated Hospital of Zhejiang University from January 2010 to January 2016. The clinical characteristics were analyzed based on the records. All the patients underwent the surgical correction in 2 stages. In the first stage, correction of ptosis was done by frontalis suspension using silicone rod. In the second stage, correction of ptosis was done by frontalis suspension using autogenous fascia lata.ResultsTen patients with severe congenital ptosis were aged 3 years or less when first visit the hospital. There were no family history. The age at first surgery was 10-36 months with average age 24 months. The age at second surgery was 4-6 years old with average age 4.7 years old. The mean preoperative palpebral fissure height of the unaffected and affected eyes was 8.25±0.46mm (range,8-9mm) and 3.75±0.45mm (range,3-4mm), respectively. In eight patients with unilateral ptosis, the mean preoperative palpebral fissure height of the affected eyes was 3.63±0.52mm (range,3-4mm), lower than the unaffected eyes significantly (P<0.05). In two patients with bilateral ptosis, the mean preoperative palpebral fissure height of the affected eyes was 4.0mm, lower than the average level significantly (P<0.05).The follow-up period between the two stages varied from 16-58 months, and that varied from 2-41 months after the second surgery. Mean postoperative palpebral fissure height of the surgical eyes was 8.83±0.94mm (range,8-10mm). In eight patients with unilateral ptosis, mean postoperative palpebral fissure height of the surgical eyes raised to 8.25±0.46mm (range,8-9mm; P<0.05). In two patients with bilateral ptosis, mean postoperative palpebral fissure height of the surgical eyes raised to 10.00±0.00mm (P<0.05). All the patients who underwent the surgery had good correction of ptosis, with equal palpebral apertures and symmetrical contour.ConclusionFor the management of severe congenital ptosis in patients younger than 3 years old, frontalis suspension using silicone rod in the first stage is a safe and effective surgical method, which is not incorporated into surrounding tissues and easily removable. When the patients grow up to 3 years old, we can choose the frontalis suspension using autogenous fascia lata in the second stage according to the actual situation. The 2-stage surgical treatment is a suitable method with satisfactorily functional and cosmetic results.