CONGENITAL PTOSIS - RESULTS OF SURGICAL-MANAGEMENT

Purpose: To determine the visual and cosmetic outcome following the su rgical correction of isolated congenital ptosis. Methods: A retrospect ive review of the outcome of isolated congenital ptosis corrected unde r the supervision of one surgeon at The Children's Hospital, Camperdow n, between January 1983 and January 1993 was examined. Some 65 patient s with 80 involved eyes were identified; 30 eyes underwent a levator r esection procedure, 40 eyes underwent a brow suspension using donor st ored fascia lata, and in 10 eyes a brow suspension was performed using mersilene mesh. Results: In 78 eyes of 63 patients, a good cosmetic r esult was achieved. In two patients (two eyes) a poor cosmetic result was achieved. These two patients refused further surgery following an undercorrection of their initial ptosis. The recurrence rates for the primary procedures were 16.7% for levator resection procedures, 35% fo r brow suspension procedures using donor fascia lata, and 30% for brow suspension surgery using mersilene mesh. Some 35.3% of eyes following mersilene slings required further surgery for granulomas and exposed mersilene mesh compared with 6% having similar complications with stor ed fascia lata. Nine patients (11.25%) had reduced visual acuity (one line or more on the Snellen chart or its equivalent with the other tes ts used) on the operated side. Only one patient was found to have sign ificant astigmatism. Conclusions: An acceptable cosmetic result was ac hieved with one operation in 75.3% of cases. In 20.8% of cases a secon d operation was required and in 3.9% of cases three or more operations were required. This series supports the view that where possible, lev ator resection is the preferred form of surgery to correct congenital ptosis. When the levator function is inadequate, brow suspension is pe rformed. The use of donor fascia lata resulted in a good cosmetic appe arance with a low occurrence of surgical side effects. Amblyopia, when strictly defined, occurred in 11.25% of eyes despite early surgery fo r severe cases and intensive amblyopia therapy. Management requires re peated follow up for early detection and introduction of occlusion the rapy or surgical ptosis correction.