Outcomes and complications of maximal levator resection for congenital Blepharoptosis with poor levator function

Objective: To evaluate the outcomes and complications of maximal levator resection as an alternative to frontalis suspension in cases of congenital blepharoptosis with poor levator function. Methods: This prospective study enrolled 39 patients with 50 eyelids, who had congenital ptosis (unilateral or bilateral) with less than or equal to 4 mm of levator excursion, and no history of ptosis surgical correction. Postoperative evaluation was conducted at 2 weeks, 6 months and 12 months; and included: margin reflex distance-1 (MRD1), lagophthalmos and complications. A post-operative MRD1 of 3 mm or more with a lid symmetry <= 1 mm was considered as successful outcome. Results: The mean age at the time of surgery was 3.8 +/- 1.7 years (range, 2 to 9 years), with 12 months follow-up duration. Successful outcomes were achieved in 72% of eyelids (36 out of 50), and recurrence was recorded in 5 eyelids (10%). Factors such as preoperative levator function and MRD1 were not correlated with postoperative results. Complications included exposure keratopathy (16%), lid crease asymmetry (8%), entropion (4%), Lid notching (4%), eyelash ptosis (10%), and conjunctival prolapse (2%). The high rate of exposure-related corneal complications was correlated to the prominent lagophthalmos at the early postoperative weeks (3.9 +/- 0.7 mm). Conclusion: Maximal levator resection is an effective treatment for congenital ptosis with poor levator function, which provides high rate of successful results and avoids complications of frontalis suspension. As the potential risk of exposure keratopathy is high, the ocular surface should be carefully screened during the early postoperative weeks.