Congenital ptosis repair-surgical, cosmetic, and functional outcome: a report of 162 cases.

OBJECTIVE To evaluate the surgical and functional outcome of congenital ptosis repair and the anisometropic changes after surgical repair of ptosis to determine the potential contribution of anisometropia to the development of refractive amblyopia. METHODS The clinical records of 162 children with congenital ptosis that had been surgically repaired between 1995 and 2006 at the Goldschleger Eye Institute were reviewed and analyzed for functional and cosmetic outcome, visual acuity status, and presence of amblyopia. RESULTS A total of 162 patients (mean age, 10 months) underwent surgical ptosis repair, of whom 120 (74%) had unilateral and 42 (26%) had bilateral ptosis. The surgeries were levator resection (47.5%), frontalis suspension (46.3%), and Fasanella-Servat (7.4%). Good functional and cosmetic outcomes were achieved in 130 (80.2%) patients, with unilateral cases showing more postoperative asymmetry. The reoperation rate was 10.4% (8/77) for levator resection, 29.3% (22/75) for frontalis suspension, and 20% (2/10) for Fasanella-Servat. There were no significant differences in visual acuity, spherical equivalent, or mean cylinder at 90° between the ptotic eyes before and after surgery (P = 0.33, P = 0.83, and P = 0.65, respectively), and compared with the sound eyes (P = 0.66, P = 0.78, and P = 0.08, respectively). The mean astigmatism correction by vector analysis after ptosis surgery was 1.1±0.68 D. CONCLUSIONS Congenital ptosis repair yields good functional and cosmetic outcome, although the reoperation rate is relatively high (19.8%). Congenital unilateral ptosis was not associated with any differences in anisometropia or astigmatism between the ptotic and sound eye.