Long-term Functional and Aesthetic Evaluation of Using a Single Rhomboid-shaped Fascial Strip for Severe Congenital Unilateral Blepharoptosis

Publication date: Available online 2 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Daisuke Sakahara, Keisuke Imai, Takeshi Masuoka, Hirokazu Shido, Kimiyo Matsumoto, Koji Kawamoto, Songsu Kang, Jumpei Tsumoto

Summary

Purpose

Surgery for congenital blephaloptosis is often performed at about 4-5 years of age. Long-term follow-up is important during facial growth. We performed frontal suspension using a single rhomboid-shaped autogenous fascial strip. We conducted a long-term evaluation of severe congenital unilateral blephaloptosis patients.

Patients and methods

334 patients with congenital blephaloptosis underwent surgery between 1994 and 2006. Of those, 192 patients had unilateral blephaloptosis with levator function less than 3mm. A retrospective analysis were extracted from those patients who could be followed-up postoperatively for at least 10 years, and had accurate clinical photographs available. Evaluation included visual acuity, palpebral fissure height (PFH) and marginal reflex distance (MRD) on photographs to compare both eyes. PHF and MRD were assessed as ratio. Morphological evaluation was based on patient and family comments. Statistical analysis included the t-test.

Results

Participants comprised 95 patients (63 male, 32 female, 43 left and 52 right). Visual acuity showed improvements. Although postoperative MRD ratio of the affected eye was significantly improved.

No clinically significant bilateral difference in postoperative PFH was seen compared to the unaffected side. The surgical results were 62 excellent, 14 good, 12 fair, 3 poor and 4 others' cases in our criteria. No major complications occurred. Satisfactory result could be seen in 76 of 95 cases.

Conclusion

Based on our evaluation, our surgical procedure appears useful for patients with unilateral congenital ptosis. Moreover, blephaloptosis surgery is useful for improving visual acuity. We report this surgical procedure and discuss the long-term results.