Clinical Efficacy Analysis Of Conjoint Fascial Sheath Suspension For Correction Of Severe Ptosis In Children

Objective.To compare and analyze the differences in clinical efficacy between the application of conjoint fascial sheath(CFS)suspension for the correction of severe congenital ptosis in children and adults.Methods.Using a retrospective analysis,a total of 39 patients(50 eyes)with severe congenital ptosis with poor levator function(≤ 4 mm)were admitted to the Eye Hospital of the Second Hospital of Jilin University from January 2018 to December2020.According to the age,all patients were divided into preschool group(3-6 years old,14 patients,18 eyes),school-age group(7-17 years old,15 patients,20 eyes),and adult(18 years old or older,10 patients,12 eyes)group.All patients treated with conjoint fascial sheath(CFS)suspension,retaining the levator muscle suspension system.All patients were assessed by using pre-and post-operative digital photographs with the open eyes and the closed eyes.The follow-up was 1 week,1month,6 months and 2 years after surgery.The main outcome measurements included palpebral fissure height(PFH),marginal reflex distance 1(MRD1)and scleral exposure.The symmetry of both eyes,complications and satisfaction in three groups were compared.Results.Within-group differences in PFH and MRD1 were statistically significant in all three groups at all postoperative time points compared with preoperative(P < 0.05).Compared with preoperative palpebral fissure height(PFH)2 years after surgery,PFH improved 4 mm in patients in the preschool group,3.5 mm in patients in the schoolage group,and 3.75 mm in patients in the adult group(P > 0.05).The postoperative correction results showed that the total correction rate was 61.11% and the recurrence rate was 27.78% in the preschool group;the total correction rate was 55% and the recurrence rate was 30% in the school-age group;and the total correction rate was66.67% and the recurrence rate was 16.67% in the adult group,with no statistically significant difference between the three groups in terms of total correction rate and recurrence rate(P > 0.05).No overcorrection was observed in any of the groups.The differences in scleral exposure between the groups were not statistically significant(P > 0.05).Patients in all groups had good eyelid closure function,and no complications such as exposure keratitis or conjunctival prolapse were observed until the last visit.Patients’ satisfaction showed a positive benefit for all groups of patients after surgery.Conclusion:CFS suspension is effective in correcting severe congenital ptosis in children aged 3-17 years old,with no significant differences in adults.