Maximal Levator Resection Beyond Whitnall’s Ligament in Severe Simple Congenital Ptosis with Poor Levator Function
Issued Date
2022-01-01
Resource Type
ISSN
11775467
eISSN
11775483
Scopus ID
2-s2.0-85125045418
Journal Title
Clinical Ophthalmology
Volume
16
Start Page
441
End Page
452
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Ophthalmology Vol.16 (2022) , 441-452
Suggested Citation
Wuthisiri W. Maximal Levator Resection Beyond Whitnall’s Ligament in Severe Simple Congenital Ptosis with Poor Levator Function. Clinical Ophthalmology Vol.16 (2022) , 441-452. 452. doi:10.2147/OPTH.S340781 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86664
Title
Maximal Levator Resection Beyond Whitnall’s Ligament in Severe Simple Congenital Ptosis with Poor Levator Function
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Purpose: To evaluate the functional and cosmetic outcomes, as well as factors that influence surgical success of maximal levator resection beyond Whitnall’s ligament in patients with poor levator function (LF) and severe simple congenital ptosis. Methods: This retrospective interventional study included patients with severe simple congenital ptosis and LF of ≤4 mm who had undergone maximal levator resection beyond Whitnall’s ligament with a minimum of 12 months follow-up. Postoperative marginal reflex distance-1 (MRD1) was assessed for functional outcomes as excellent, good, fair and poor. Eyelid contour and the difference in MRD1 between eyes were assessed for symmetrical cosmetic outcomes as excellent, good and poor. Demographic data, factors influencing surgical success and postoperative complications were analyzed. Results: A total of 38 ptotic eyelids in 31 patients were included. Successful surgical outcomes (at least good functional and cosmetic outcomes) were achieved in 26 patients (83.87%) with the mean MRD1 of +3.61 ± 0.27 mm and +3.51 ± 0.17 mm at 1 week and 12 months after surgery, respectively. There were no significant differences in demographic and preoperative data between the successful and unsuccessful surgical outcome groups, mean preoperative ptosis measurements were 4.19 ± 0.20 mm versus 4.72 ± 0.36 mm (p = 0.242) and mean pre-operative LF were 3.16 ± 0.15 mm versus 2.29 ± 0.61 mm (p = 0.561), respectively. The only factor that significantly influenced the surgical success rate was the length of the resected levator muscle. The mean lengths in successful and unsuccessful groups were 18.15 ± 0.44 mm and 14.29 ± 0.94 mm, respectively (p = 0.011). Conclusion: Maximal levator resection beyond Whitnall’s ligament is an effective procedure for severe simple congenital ptosis with poor LF. Refinement of surgical techniques and careful assessment of the optimal resected length for the levator muscle grants successful surgical outcomes.