Abstract
Purpose: :
To assess the efficacy of modified levator plication in the correction of severe congenital ptosis with poor levator action and its comparative evaluation withfrontalis sling surgery using autogenous fascia lata.
Methods: :
Prospective study involving patients (>4 yrs) with severe (≥ 4mm) congenital ptosis with poor (≤ 4mm) LPS action. Ten patients each were randomized for the modified technique of levator plication (11 eyelids: Group 1) and frontalis sling surgery (12 eyelids: Group 2). The technique of levator plication involved dis-insertion of levator aponeurosis from its medial and lateral horns. Double triangle technique similar to Crawford’s technique utilizing autogenous fascia lata was used for frontalis sling surgery. Patients were followed up for a minimum period of 3 months.
Results: :
The mean age was 11.2±2.31 years in Group 1 and 14.4±3.82 years in Group 2 (p= 0.091). The groups were comparable in terms of pre-operative degree of ptosis and levator action. The mean post operative PAH in primary gaze at 3 months was 6.9 ± 1.22 mm in Group 1 and 7.0 ± 1.47 mm in Group 2 (p= 0.79). Mean PAH in down gaze was 6.63 ± 1.20 mm in Group 1 and 8.33 ± 1.61 mm in Group 2 (p= 0.012). Mean amount of correction was 4.36 ± 0.80 mm in Group 1 and 5.08 ± 1.37 mm in Group 2 (p= 0.16). Mean post-operative lid lag was 0.54 ± 0.52 mm in Group 1 and 1.25 ± 0.62 mm in Group 2 (p=0.011). Mean lagophthalmos in Group 1 was 0.36 ± 0.50 mm and 1.08 ± 0.79 mm in Group 2 (p= 0.025). 81.82% patients had good lid fold in Group 1 and 66.66% in Group 2. One eyelid had over-correction at 3 months in Group 2. Both groups had 2 under-corrected lids.Two patients had transient exposure keratopathy in Group 2. One lid had notching in Group 2. One patient had a conjunctival prolapse in Group 1 managed surgically.
Conclusions: :
This modified technique of levator plication thus produces satisfactory ptosis correction comparable to the standard technique of frontalis sling surgery for severe congenital ptosis with poor levator function.There was a significantly less amount of lagophthalmos and lid lag in the modified plication group. There were no corneal complications,no lid contour defects and higher percentage of patients had a good post-operative lid fold in the modified plication group . Thus modified levator plication can be considered as an effective surgical alternative for such cases.
Clinical Trial: :
Institutional Ethics Committee, AIIMS,New Delhi, DC-R-10214
Keywords: eyelid • orbit • ocular motor control