Methods of surgical treatment of congenital ptosis (review)

Abstract

Congenital ptosis is one of the most common eyelid abnormalities in the field of pediatric ophthalmology. This condition is characterized by drooping of the upper eyelid and can lead to functional and aesthetic problems in children in the absence of timely treatment. Various surgical methods aimed at correcting blepharoptosis are described in the literature, including levator resection, frontalis sling and tarsomullerectomy. Levator resection is the most common technique that significantly improves the position of the upper eyelid and provides lasting functional results. Frontalis sling is usually used for severe ptosis or in cases where levator resection is impractical. Tarzomullerectomy surgery is also frequently used, especially in patients with sufficient levator function. An important aspect of surgical treatment is the need for preoperative diagnosis of the degree of ptosis, levator function, and the presence of concomitant abnormalities such as amblyopia and strabismus. The results of surgical procedure show a high degree of patient satisfaction, however, they require constant monitoring to identify possible complications and the need for repeated intervention. Thus, the choice of surgical treatment method should take into account the individual anatomical and physiological characteristics of the patient.

Keywords

congenital ptosis / oculoplastic pathology / surgical treatment of congenital ptosis / levator resection

References

[1] Schaefer AJ, Schaefer DP. Classifcation and correction of ptosis. In: William BS, editor. Surgery of the eyelid, orbit, and lacrimal system (American Academy of Ophthalmology Monograph Series). 2nd ed. Great Britain: Oxford University Press; 1994. P. 84–134.

[2] Schaefer A.J., Schaefer D.P. Classification and correction of ptosis. В кн.: Surgery of the eyelid, orbit, and lacrimal system (American Academy of Ophthalmology Monograph Series). 2nd ed. / B.S. William, editor. Great Britain: Oxford University Press, 1994. P. 84–134.

[3] Griepentrog GJ, Diehl NN, Mohney BG. Incidence and demographics of childhood ptosis. Ophthalmology. 2011;118(6):1180–1183. doi: 10.1016/j.ophtha.2010.10.026

[4] Griepentrog G.J., Diehl N.N., Mohney B.G. Incidence and demographics of childhood ptosis // Ophthalmology. 2011. Vol. 118, N 6. P. 1180–1183. doi: 10.1016/j.ophtha.2010.10.026

[5] Stein A, Kelly JP, Weiss AH. Congenital eyelid ptosis: onset and prevalence of amblyopia, associations with systemic disorders, and treatment outcomes. J Pediatr. 2014;165(4):820–824.e2. doi: 10.1016/j.jpeds.2014.06.053

[6] Stein A., Kelly J.P., Weiss A.H. Congenital eyelid ptosis: onset and prevalence of amblyopia, associations with systemic disorders, and treatment outcomes // J Pediatr. 2014. Vol. 165, N 4. P. 820–824.e2. doi: 10.1016/j.jpeds.2014.06.053

[7] Anderson RL, Baumgartner SA. Amblyopia in ptosis. Arch Ophthalmol. 1980;98(6):1068–1069. doi: 10.1001/archopht.1980.01020031058009

[8] Anderson R.L., Baumgartner S.A. Amblyopia in ptosis // Arch Ophthalmol. 1980. Vol. 98, N 6. P. 1068–1069. doi: 10.1001/archopht.1980.01020031058009

[9] Efimova EL. Visual impairment in children with congenital blepharoptosis. Modern technologies in ophthalmology. 2020;35(4): 209–210. doi: 10.25276/2312-4911-2020-4-209-210 EDN: SFLBIB

[10] Ефимова Е.Л. Нарушение зрительных функций у детей с врожденным птозом верхнего века // Современные технологии в офтальмологии. 2020. Т. 35, № 4. С. 209–210. doi: 10.25276/2312-4911-2020-4-209-210 EDN: SFLBIB

[11] Afanasyeva PS. Frequency of ametropia, ocular mobility disorders and amblyopia in children with congenital ptosis. Forcipe. 2020;3(S1):630. EDN: DFFGKR (In Russ.)

[12] Афанасьева П.С. Частота встречаемости аметропий, нарушения подвижности глазного яблока и амблиопии у детей с врождённым птозом // Forcipe. 2020. Т. 3, № S1. С. 630. EDN: DFFGKR

[13] Wang Y, Xu Y, Liu X, et al. Amblyopia, strabismus and refractive errors in congenital ptosis: a systematic review and meta-analysis. Sci Rep. 2018;8(1):8320. doi: 10.1038/s41598-018-26671-3

[14] Wang Y., Xu Y., Liu X., et al. Amblyopia, strabismus and refractive errors in congenital ptosis: a systematic review and meta-analysis // Sci Rep. 2018. Vol. 8, N 1. ID 8320. doi: 10.1038/s41598-018-26671-3

[15] Dransart HN. Un cas de blépharoptose opéré par un procédé spécial à l’auteur. Healing. Analectes Ophtalmol. 1880;84:88. (In French).

[16] Dransart H.N. Un cas de blépharoptose opéré par un procédé spécial à l’auteur // Guerison. Analectes Ophtalmol. 1880. Vol. 84. P. 88.

[17] Siemerling E. Anatomischer Befund bei einseitiger congenitaler Ptosis. Eur Arch Psychiatry Clin Neurosci. 1892;23:764–774. doi: 10.1007/BF01846107 (In German)

[18] Siemerling E. Anatomischer Befund bei einseitiger congenitaler Ptosis // Eur Arch Psychiatry Clin Neurosci. 1892. Vol. 23. P. 764–774. doi: 10.1007/BF01846107

[19] Kataev MG, Dzagurova ZR, Shatskikh AV, et al. Müller muscle of the upper eyelid: pathohistologic picture in congenital and acquired ptosis. Point of view. East–West. 2019;(3):20–23. doi: 10.25276/2410-1257-2019-3-20-23 EDN: JJRMQF (In Russ.)

[20] Катаев М.Г., Дзагурова З.Р., Шацких А.В., и др. Мышца Мюллера верхнего века: патогистологическая картина при врождённом и приобретенном птозах // Точка зрения. Восток–Запад 2019. № 3. С. 20–23. doi: 10.25276/2410-1257-2019-3-20-23 EDN: JJRMQF

[21] Filatova IA, Iomdina EN, Sitnikova DN. Biochemical characteristics of the upper eyelid tissues in the children with congenital ptosis. Russian pediatric ophthalmology. 2012;(2):34–37. EDN: PUHMNR

[22] Филатова И.А., Иомдина Е.Н., Ситникова Д.Н. Биомеханические параметры тканей верхнего века при врождённом птозе у пациентов детского возраста // Российская педиатрическая офтальмология. 2012. № 2. С. 34–37. EDN: PUHMNR

[23] Setty G, Khan A, Saleem R, Hussain N. A rare cause of congenital ptosis: Blepharophimosis, ptosis and epicanthus inversus syndrome. J Pediatr Neurosci. 2012;7(3):238–239. doi: 10.4103/1817-1745.106493

[24] Setty G., Khan A., Saleem R., Hussain N. A rare cause of congenital ptosis: Blepharophimosis, ptosis and epicanthus inversus syndrome // J Pediatr Neurosci. 2012. Vol. 7, N 3. P. 238–239. doi: 10.4103/1817-1745.106493

[25] Leon-Mateos A, Ginarte M, Ruiz-Ponte C, et al. Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Int J Dermatol. 2007;46(1):61–63. doi: 10.1111/j.1365-4632.2007.03066.x

[26] Leon-Mateos A., Ginarte M., Ruiz-Ponte C., et al. Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) // Int J Dermatol. 2007. Vol. 46, N 1. P. 61–63. doi: 10.1111/j.1365-4632.2007.03066.x

[27] Clauser L, Tieghi R, Galiè M. Palpebral ptosis: clinical classification, differential diagnosis, and surgical guidelines: an overview. J Craniofac Surg. 2006;17(2):246–254. doi: 10.1097/00001665-200603000-00008

[28] Clauser L., Tieghi R., Galiè M. Palpebral ptosis: clinical classification, differential diagnosis, and surgical guidelines: an overview // J Craniofac Surg. 2006. Vol. 17, N 2. P. 246–254. doi: 10.1097/00001665-200603000-00008

[29] Berke RN. Congenital ptosis; a classification of 200 cases. Arch Ophthal. 1949;41(2):188–197. doi: 10.1001/archopht.1949.00900040193006

[30] Berke R.N. Congenital ptosis; a classification of 200 cases // Arch Ophthal. 1949. Vol. 41, N 2. P. 188–197. doi: 10.1001/archopht.1949.00900040193006

[31] Grusha YO, Fisenko NV, Blinova IV. Blepharoptosis: diagnostic tests. Russian annals of ophthalmology. 2016;132(3):61–65. doi: 10.17116/oftalma2016132361-65 EDN: WCZGKT

[32] Груша Я.О., Фисенко Н.В., Блинова И.В. Блефароптоз: диагностические тесты // Вестник офтальмологии. 2016. Т. 132, № 3. С. 61–65. doi: 10.17116/oftalma2016132361-65 EDN: WCZGKT

[33] Ivolgina IV, Fabrikantov OL. Ptosis of the upper eyelid. Surgical treatment. Choice of the method of surgery. Modern technologies in ophthalmology. 2017;(3):212–214. EDN: ZENQUL (In Russ.)

[34] Иволгина И.В., Фабрикантов О.Л. Птоз верхнего века. Хирургическое лечение. Выбор метода операции // Современные технологии в офтальмологии. 2017. № 3. С. 212–214. EDN: ZENQUL

[35] Potyomkin VV, Goltsman EV. Algorithm of objective examination of a patient with blepharoptosis. Ophthalmology Reports. 2019;12(1):45–51. doi: 10.17816/OV2019145-51 EDN: QGSASP

[36] Потемкин В.В., Гольцман Е.В. Алгоритм объективного осмотра пациента с блефароптозом // Офтальмологические ведомости. 2019. Т. 12, № 1. С. 45–51. doi: 10.17816/OV2019145-51 EDN: QGSASP

[37] Jarulla-zade ICh. To the cause analysis for reoperations of congenital ptosis. Point of view. East–West. 2018;(3):102–105. doi: 10.25276/2410-1257-2018-102-105 EDN: XRDPSH

[38] Джаруллазаде И.Ч. К анализу причин реопераций врождённого птоза // Точка зрения. Восток–Запад. 2018. № 3. С. 102–105. doi: 10.25276/2410-1257-2018-102-105 EDN: XRDPSH

[39] Bai J-S, Song M-J, Li B-T, Tian R. Timing of surgery and treatment options for congenital ptosis in children: A narrative review of the literature. Aesthetic Plast Surg. 2023;47(1):226–234. doi: 10.1007/s00266-022-03039-7

[40] Bai J.-S., Song M.-J., Li B.-T., Tian R. Timing of surgery and treatment options for congenital ptosis in children: A narrative review of the literature // Aesthetic Plast Surg. 2023. Vol. 47, N 1. P. 226–234. doi: 10.1007/s00266-022-03039-7

[41] Ben Simon GJ, MacEdo AA, Schwarcz RM, et al. Frontalis suspension for upper eyelid ptosis: evaluation of different surgical designs and suture material. Am J Ophthalmol. 2005;140(5):877–885. doi: 10.1016/j.ajo.2005.05.031

[42] Ben Simon G.J., MacEdo A.A., Schwarcz R.M., et al. Frontalis suspension for upper eyelid ptosis: evaluation of different surgical designs and suture material // Am J Ophthalmol. 2005. Vol. 140, N 5. P. 877–885. doi: 10.1016/j.ajo.2005.05.031

[43] Rosenberg JB, Andersen J, Barmettler A. Types of materials for frontalis sling surgery for congenital ptosis. Cochrane Database Syst Rev. 2019;4(4):CD012725. doi: 10.1002/14651858.CD012725.pub2

[44] Rosenberg J.B., Andersen J., Barmettler A. Types of materials for frontalis sling surgery for congenital ptosis // Cochrane Database Syst Rev. 2019. Vol. 4, N 4. ID CD012725. doi: 10.1002/14651858.CD012725.pub2

[45] Patent RUS No. 2553944/ 20.06.2015. Byul. No. 17. Korotkikh SA, Zakharova TA, Stepanova EA. Method of surgical treatment of upper eyelid ptosis with absence of levator function in children. Available from: https://patenton.ru/patent/RU2553944C1.pdf. Cited: 01 Jul 2024

[46] Патент РФ на изобретение № 2553944/ 20.06.2015. Бюл. № 17. Коротких С.А., Захарова Т.А., Степанова Е.А. Способ хирургического лечения птоза верхнего века с отсутствием функции леватора у детей. Режим доступа: https://patenton.ru/patent/RU2553944C1.pdf. Дата обращения: 01.07.2024

[47] Patent RUS No. 2749802/ 17.06.2021. Byul. No. 17. Kataev MG, Zakharova TA. Method of surgical treatment of upper eyelid ptosis with poor or no levator function. Available from: https://patenton.ru/patent/RU2749802C1.pdf. Cited: 01 Jul 2024

[48] Патент РФ на изобретение № 2749802/ 17.06.2021. Бюл. № 17. Катаев М.Г., Захарова М.А. Способ хирургического лечения птоза верхнего века при плохой или отсутствии функции леватора. Режим доступа: https://patenton.ru/patent/RU2749802C1.pdf. Дата обращения: 01.07.2024

[49] Patent RUS No. 2440073/ 20.01.2012. Byul. No. 2. Filatova IA. Method of surgical management of severe blepharoptosis. Available from: https://patenton.ru/patent/RU2440073C1.pdf. Cited: 01 Jul 2024

[50] Патент РФ на изобретение № 2440073/ 20.01.2012. Бюл. № 2. Филатова И.А. Способ хирургического лечения птоза верхнего века тяжёлой степени. Режим доступа: https://patenton.ru/patent/RU2440073C1.pdf. Дата обращения: 01.07.2024

[51] Chen L, Li J, Zhang C, et al. Surgical interventions for congenital ptosis: a systematic review and meta-analysis of 14 randomized controlled trials. Aesthetic Plast Surg. 2023;47(5):1859–1869. doi: 10.1007/s00266-023-03360-9

[52] Chen L., Li J., Zhang C., et al. Surgical interventions for congenital ptosis: a systematic review and meta-analysis of 14 randomized controlled trials // Aesthetic Plast Surg. 2023. Vol. 47, N 5. P. 1859–1869. doi: 10.1007/s00266-023-03360-9

[53] Gazzola R, Piozzi E, Vaienti L, Wilhelm Baruffaldi Preis F. Therapeutic algorithm for congenital ptosis repair with levator resection and frontalis suspension: Results and literature review. Semin Ophthalmol. 2018;33(4):454–460. doi: 10.1080/08820538.2017.1297840

[54] Gazzola R., Piozzi E., Vaienti L., Wilhelm Baruffaldi Preis F. Therapeutic algorithm for congenital ptosis repair with levator resection and frontalis suspension: Results and literature review // Semin Ophthalmol. 2018. Vol. 33, N 4. P. 454–460. doi: 10.1080/08820538.2017.1297840

[55] Feldman I, Brusasco L, Malhotra R. Improving outcomes of posterior approach levatorpexy for congenital ptosis with reduced levator function. Ophthalmic Plast Reconstr Surg. 2018;34(5):460–462. doi: 10.1097/IOP.0000000000001056

[56] Feldman I., Brusasco L., Malhotra R. Improving outcomes of posterior approach levatorpexy for congenital ptosis with reduced levator function // Ophthalmic Plast Reconstr Surg. 2018. Vol. 34, N 5. P. 460–462. doi: 10.1097/IOP.0000000000001056

[57] Lukyanova EE, Ishbulatov RSh. Differentiated approach to the choice of the method of surgical treatment of congenital ptosis of the upper eyelid in patients under 18 years of age. Modern technology in ophthalmology. 2019;(3):127–129. doi: 10.25276/2312-4911-2019-3-127-129 EDN: WZMMNN

[58] Лукьянова Е.Э., Ишбулатов Р.Ш. Дифференцированный подход к выбору метода хирургического лечения врождённого птоза верхнего века у пациентов до 18 лет // Современные технологии в офтальмологии. 2019. № 3. С. 127–129. doi: 10.25276/2312-4911-2019-3-127-129 EDN: WZMMNN

[59] Mazurina OV, Kolenko OV, Pshenichnov MV, et al. Effectiveness of dosed surgical resection of upper eyelid’s levator in children’s congenital blepharoptosis treatment. Russian ophthalmology of children. 2023;(4):5–10. doi: 10.25276/2307-6658-2023-4-5-10 EDN: EWRSGV

[60] Мазурина О.В., Коленко О.В., Пшеничнов М.В., и др. Анализ эффективности дозированной хирургической резекции леватора верхнего века при лечении врождённого блефароптоза у детей // Российская детская офтальмология. 2023. № 4. С. 5–10. doi: 10.25276/2307-6658-2023-4-5-10 EDN: EWRSGV

[61] Koka K, Patel BC. Ptosis correction. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024.

[62] Koka K., Patel B.C. Ptosis correction. В кн.: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024.

[63] Patent RUS No. 2627366/ 07.08.2017. Byul. No. 22. Shakhmatova AV, Shakhmatova IP, Pashtaev NP, Pozdeeva N.A. Method for surgical treatment of non-dystrophic blepharoptosis. Available from: https://patenton.ru/patent/RU2627366C1.pdf. Cited: 01 Jul 2024

[64] Патент РФ на изобретение № 2627366/ 07.08.2017. Бюл. № 22. Шахматова А.В., Шахматова И.П., Паштаев Н.П., Поздеева Н.А. Способ хирургического лечения недистрофического блефароптоза. Режим доступа: https://patenton.ru/patent/RU2627366C1.pdf. Дата обращения: 01.07.2024

[65] Patent RUS No. 2605657/ 27.12.2016. Byul. No. 36. Korotkikh SA, Zakharova TA, Berezin AV, Stepanova EA. Method of surgical treatment ofblepharoptosis accompanying preserved and decreased levator function. Available from: https://patenton.ru/patent/RU2605657C1.pdf. Cited: 01 Jul 2024

[66] Патент РФ на изобретение № 2605657/ 27.12.2016. Бюл. № 36. Коротких С.А., Захарова Т.А., Березин А.В., Степанова Е.А. Способ хирургического лечения птоза верхнего века при сохранной или сниженной функции леватора. Режим доступа: https://patenton.ru/patent/RU2605657C1.pdf. Дата обращения: 01.07.2024

[67] Patent RUS No. 2772534/ 23.05.2022. Byul. No. 15. Filatova IA, Kondrateva YP, Shemetov SA, et al. Method for surgical treatment of ptosis of the upper eyelid of moderate and severe degree. Available from: https://patenton.ru/patent/RU2772534C1.pdf. Cited: 01 Jul 2024

[68] Патент РФ на изобретение № 2772534/ 23.05.2022. Бюл. № 15. Филатова И.А., Кондратьева Ю.П., Шеметов С.А., и др. Способ хирургического лечения птоза верхнего века средней и тяжёлой степени. Режим доступа: https://patenton.ru/patent/RU2772534C1.pdf. Дата обращения: 01.07.2024

[69] Kasaee A, Aliabadi M, Najafi L, Jamshidian-Tehrani M. Severe unilateral congenital ptosis with poor levator function: tarsoconjunctival mullerectomy plus levator resection vs frontalis sling procedure. Int J Ophthalmol. 2022;15(8):1254–1260. doi: 10.18240/ijo.2022.08.05

[70] Kasaee A., Aliabadi M., Najafi L., Jamshidian-Tehrani M. Severe unilateral congenital ptosis with poor levator function: tarsoconjunctival mullerectomy plus levator resection vs frontalis sling procedure // Int J Ophthalmol. 2022. Vol. 15, N 8. P. 1254–1260. doi: 10.18240/ijo.2022.08.05

[71] Souther SG, Corboy JM, Thompson JB. The Fasanella–Servat operation for ptosis of the upper eyelid. Plast Reconstr Surg. 1974;53(2):123–128. doi: 10.1097/00006534-197402000-00001.

[72] Souther S.G., Corboy J.M., Thompson J.B. The Fasanella–Servat operation for ptosis of the upper eyelid // Plast Reconstr Surg. 1974. Vol. 53, N 2. P. 123–128. doi: 10.1097/00006534-197402000-00001.

[73] Goltsman EV. Surgical treatment of patients with blepharoptosis by transconjunctival access [dissertation]. Moscow, 2021. 117 p. (In Russ.)

[74] Гольцман Е.В. Хирургическое лечение пациентов с блефароптозом трансконъюнктивальным доступом: дис. … канд. мед. наук. Москва, 2021. 117 с.

[75] Goltsman EV, Potemkin VV, Davydov DV. The main prognostic factors influencing the results of the superior tarsal muscle resection in patients with blepharoptosis. Ophthalmology Reports. 2020;13(3):7–12. doi: 10.17816/OV25740 EDN: SWMVVN

[76] Гольцман Е.В., Потемкин В.В., Давыдов Д.В. Основные прогностические факторы влияния на результат резекции верхней тарзальной мышцы у пациентов с блефароптозом // Офтальмологические ведомости. 2020. Т. 13, № 3. C. 7–12. doi: 10.17816/OV25740 EDN: SWMVVN

[77] Bilici S, Harbigil-Sever T, Ugurbas SH. Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller’s muscle conjunctival resection. Arq Bras Oftalmol. 2024;87(3):e20230028. doi: 10.5935/0004-2749.2023-0028

[78] Bilici S., Harbigil-Sever T., Ugurbas S.H. Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller’s muscle conjunctival resection // Arq Bras Oftalmol. 2024. Vol. 87, N 3. ID e20230028. doi: 10.5935/0004-2749.2023-0028

[79] Danesh J, Ugradar S, Goldberg R, Rootman DB. A novel technique for the measurement of eyelid contour to compare outcomes following Muller’s muscle-conjunctival resection and external levator resection surgery. Eye (Lond). 2018;32(9):1493–1497. doi: 10.1038/s41433-018-0105-4

[80] Danesh J., Ugradar S., Goldberg R., Rootman D.B. A novel technique for the measurement of eyelid contour to compare outcomes following Muller’s muscle-conjunctival resection and external levator resection surgery // Eye (Lond). 2018. Vol. 32, N 9. P. 1493–1497. doi: 10.1038/s41433-018-0105-4

[81] Zakharova TA. Development of surgical rehabilitation of children with congenital ptosis of the upper eyelid [dissertation abstract]. Yekaterinburg, 2016. 22 p. (In Russ.)

[82] Захарова Т.А. Развитие хирургической реабилитации детей с врожденным птозом верхнего века: автореф. дис. … канд. мед. наук. Екатеринбург, 2016. 22 с.

[83] Filatova IA, Shemetov SA. The analysis of complications due to the erroneous strategy of the surgical treatment of the upper lid ptosis. Russian Pediatric Ophthalmology. 2016;11(2):89–92. doi: 10.18821/1993-1859-2016-11-2-89-92 EDN: VXEJLL

[84] Филатова И.А., Шеметов С.А. Анализ осложнений из-за неверной тактики хирургического лечения птоза верхнего века // Российская педиатрическая офтальмология. 2016. Т. 11, № 2. С. 89–92. doi: 10.18821/1993-1859-2016-11-2-89-92 EDN: VXEJLL

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