Modified Technique and Ptosis Clamp for Surgical Correction of Congenital Pediatric Ptosis by Anterior Levator Resection

ABSTRACT

Congenital ptosis is due to a dysgenesis of the levator complex with the levator muscle being replaced by fatty and fibrous tissue. This dysfunction of the levator muscle gives rise to the classic triad of findings in congenital ptosis, including ptosis in the primary position, lagophthalmos in downgaze, and a poorly formed eyelid crease. There are traditionally two ways to surgically correct congenital ptosis, levator resection and frontalis suspension (by utilizing a myriad of both autogenous and synthetic materials). Although frontalis suspension is the more utilized surgical option for the correction of congenital ptosis, the complication rate due to the use of synthetic materials is not insignificant. Many surgeons feel that the contour and appearance of the eyelid following levator resection is superior to the frontalis suspension technique. Thus, levator resection for congenital ptosis can be one of the most satisfactory and physiologically normal of the ptosis procedures. Surgery for congenital ptosis can however be unpredictable in outcome. We propose a modified technique for levator resection as well as a newly designed and modified Berke ptosis clamp for levator resection surgery. Postoperative results with the modified technique as well as clamp have been very encouraging with excellent postoperative lid contour and height. The author has utilized this clamp and modified technique in over 350 lid surgeries over the past ten years.

KEYWORDS

Congenital ptosis - levator resection - Berke ptosis clamp

REFERENCES

• 1 Whitehouse G M, Grigg J R, Martin F J. Congenital ptosis: results of surgical management.  Aust N Z J Ophthalmol. 1995;  23 309-314
• 2 Wagner R S, Mauriello J A, Nelson L B et al.. Treatment of congenital ptosis with frontalis suspension: a comparison of suspensory materials.  Ophthalmology. 1984;  91 245-248
• 3 Fox S A. Ophthalmic Plastic Surgery. New York; Grune & Stratton 1963
• 4 Hornblass A. Oculoplastic, Orbital, and Reconstructive Surgery: Volume One, Eyelids. Baltimore, MD; Williams and Wilkins 1988
• 5 Smith B, Converse J M. Proceedings of the Second International Symposium on Plastic and Reconstructive Surgery of the Eye and Adnexa. St. Louis, MO; CV Mosby 1967
• 6 Berke R N. Results of resection of the levator muscle through a skin incision in congenital ptosis.  Arch Ophthalmol. 1959;  61 25-49
• 7 Cates C A, Tyers A G. Outcomes of anterior levator resection in congenital blepharoptosis.  Eye. 2001;  15 770-773
• 8 Beard C. Ptosis. 3rd ed. St. Louis, MO; CV Mosby 1981
• 9 Press U P, Hubner H. Maximal levator resection in the treatment of unilateral congenital ptosis with poor levator function.  Orbit. 2001;  20 125-129
• 10 Epstein G A, Putterman A M. Super-maximum levator resection for severe unilateral congenital blepharoptosis.  Ophthalmic Surg. 1984;  15 971-978
• 11 Berlin A J, Vestal K P. Levator aponeurosis surgery: a retrospective review.  Ophthalmology. 1989;  96 1033-1037
• 12 Blomgren I, Holmstrom H. Anterior levator resection in congenital genuine blepharoptosis.  Scand J Plast Reconstr Surg. 1986;  20 189-195
• 13 Jordan D R, Anderson R L. The aponeurotic approach to congenital ptosis.  Ophthalmic Surg. 1990;  21 237-244