Lagophthalmos after congenital ptosis surgery: comparison between maximal levator resection and frontalis sling operation

Background/Objectives To compare postoperative lagophthalmos after maximal levator resection (MLR) and frontalis suspension (FS) in congenital ptosis patients with poor levator function (LF). Methods A cross-sectional study was performed to compare postoperative outcomes in patients with preoperative LF <= 4 mm who had undergone MLR or FS at a single tertiary institution, and who had visited the outpatient clinic between February 2017 and August 2018. Main outcome measures were as follows: (1) Preoperative LF and margin reflex distance 1 (MRD1), (2) Postoperative MRD1, lagophthalmos and grade of superficial punctate keratopathy (SPK). Results Our study comprised 152 eyelids of 122 patients. There were 71 eyelids in the MLR group and 81 eyelids in the FS group. The MLR group had comparable mean postoperative MRD1 (2.8 +/- 0.8 mm) to the FS with autogenous fascia lata (AFL) group (3.0 +/- 0.7 mm), while the FS with preserved fascia lata (PFL) group had the lowest mean postoperative MRD1 (2.2 +/- 1.0 mm). The PFL group had significantly less lagophthalmos (0.6 +/- 1.0 mm) than the AFL (1.9 +/- 1.4 mm) and maximal levator resection (1.9 +/- 1.7 mm) groups. In the MLR group, there was no significant difference in postoperative surgical measurements between the LF 0-2 mm group and LF 2.5-4 mm group in terms of exposure keratopathy, degree of lagophthalmos and MRD1. Conclusion MLR is an effective alternative to FS in congenital ptosis patients with poor levator function, with the risk of postoperative lagophthalmos related to postoperative MRD1 rather than preoperative LF.