Maximal levator resection in unilateral congenital ptosis with poor levator function

Background/aims Surgical treatments for the correction of congenital ptosis with poor levator function, including frontalis suspension or maximal levator resection, remain controversial. We evaluated the postoperative surgical and cosmetic outcomes after maximal levator resection for unilateral congenital ptosis with poor levator function. Methods A retrospective, interventional case series was performed. A total of 243 patients with 243 eyelids (210 unilateral and 33 bilateral asymmetric ptosis) who underwent unilateral maximal levator resection were included. The surgical results were graded as excellent, good and poor and postoperative complications were documented. Results The mean age at the time of surgery was 8.8±9.7 years (range, 2–58 years) with mean follow-up time of 40.9±38.9 months (range, 3 months to 18.9 years). Satisfactory results (excellent or good result) were obtained in 93.0% of the patients. Patients were divided into two groups based on levator function as follows: 0–2 mm (80 cases) and 2.5–4.0 mm (163 cases). Factors such as preoperative levator function, margin reflex distance-1 and levator dehiscence were not correlated with postoperative surgical outcomes. Complications included exposure keratopathy (11.1%), lid crease asymmetry (8.2%), entropion (8.2%), overcorrection (3.3%), eyelash ptosis (3.7%), temporal eyelid droop (3.3%), suture abscess (0.8%) and conjunctival prolapse (0.8%). Conclusions Maximal levator resection is an effective procedure for congenital ptosis even in patients with poor levator function, which provides improved cosmesis, a more natural lid contour, and avoids brow scars.