Original article
Factors Associated With Surgical Outcomes in Congenital Ptosis: A 10-Year Study of 319 Cases

https://doi.org/10.1016/j.ajo.2016.12.013Get rights and content

Purpose

To evaluate the 10-year results of surgery for congenital ptosis and identify factors associated with excellent outcomes and recurrence.

Design

Retrospective, interventional case series.

Methods

A retrospective analysis was conducted of 319 patients who underwent surgical correction at a tertiary medical center for congenital ptosis. The main outcome measures were postoperative surgical outcomes and recurrence rates. Excellent lid height was assessed as a marginal reflex distance (MRD) greater than 3 mm. Recurrence was defined as a lid height less than 50% of the initial postoperative lid height.

Results

The overall surgical success rate was 97.2%. On multivariate analysis, 3 factors were significantly associated with a greater probability of achieving excellent lid height: treatment using levator muscle resection (LMR) (adjusted odds ratio [OR], 1.76; P = .04), better preoperative MRD (adjusted OR, 2.21; P < .001), and absence of Marcus Gunn (jaw-winking) syndrome (adjusted OR, 0.12; P = .01). For recurrence, 7 significant risk factors were identified: children less than 1 year old (adjusted OR, 4.92; P = .02), poorer preoperative MRD (adjusted OR, 0.64; P = .04), poorer postoperative MRD (adjusted OR, 0.32; P < .001), treatment with frontalis suspension (FS) (adjusted OR, 5.86; P < .001), wound infection (adjusted OR, 9.45; P = .02), postoperative entropion (adjusted OR, 11.25; P = .003), and conjunctival prolapse (adjusted OR, 7.10; P = .03). Kaplan-Meier analysis showed that the 1-, 5-, and 10-year recurrence-free rates were 97.3% ± 1.2%, 80.5% ± 4.4%, and 76.7% ± 5.6%, respectively, for the LMR group and 90.9% ± 3.1%, 42.9% ± 8.1%, and 20.8% ± 10.1%, respectively, for the FS group (P < .001, log-rank test).

Conclusions

Surgical treatment of congenital ptosis had a high success rate. Identifying the risk factors and taking appropriate measures may result in better surgical outcomes and less recurrence. Our retrospective study showed that the likelihood of achieving excellent outcomes with lower recurrence rates was higher with LMR than with FS. However, a prospective randomized study is necessary to clarify their efficacy.

Section snippets

Methods

This retrospective study followed the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of Chang Gung Memorial Hospital (CGMH), Taiwan (104-8979B) in 2016. A waiver of consent was granted because of the retrospective nature of the project and anonymous analysis of data.

We retrospectively reviewed the medical records of all patients with congenital ptosis diagnosed and treated at the Department of Ophthalmology, CGMH, between January 1, 2006 and December

Demographics

Of the 319 patients enrolled in this study, 205 (64.3%) were male, and the distribution difference between sexes was significant (P < .001). Among the patients, 77.7% had unilateral ptosis and 22.3% had bilateral ptosis. In the unilateral group, the laterality of the affected eye was evenly distributed. Regarding the severity of ptosis, 79.7% of cases were severe, 18.5% were moderate, and 1.8% were mild.

The mean age at surgery was 3.86 ± 2.85 years. Age group analysis showed that 78 patients

Discussion

The definitive treatment for congenital ptosis is surgery, and the primary goal is to restore the eyelid position to as normal a level as possible. The main challenges to effective treatment are the optimal timing of surgery and the type of surgery, which may vary from case to case.17 Surgical correction of congenital ptosis is delayed as much as possible to ensure better surgical outcome if there is no risk of amblyopia.3 Early surgery may be indicated if visual development is compromised, as

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