Correction Of Severe Congenital Blepharoptosis By Conjoint Fascial Sheath Suspension Combined With Levator Muscle Resection

Objective To evaluate the cosmetic and functional outcome of conjoint facial sheath(CFS)suspension combined with levator muscle resection to correcte the patients with severe congenital blepharoptosis and poor levator function.Methods Retrospective analyze the clinical data of twelve patients with fourteen eyelids from January 2016 to December 2016,which were diagnosed as severe congenital blepharoptosis in the The Second Hospital of Dalian Medical University.All the patients underwent the surgery of conjoint facial sheath(CFS)suspension combined with levator muscle resection.Preoperative assessment were recorded such as visual acuity,palperal fissure height,margin reflex distance of the upper lid(MRD1)et al.Postoperatively,patients were followed up for three to twelve months.Postoperative measurements include: MRD1,the contour of the upper eyelid,the degree of hypophasis and complications.The preoperative and postoperative assessment were operated by the same examiner during primary gaze,with neutral head position.Results In our series of 14 blepharoptosis in 12 patients,10 were single eye,while the other 2patients were bilateral.Their mean age was 22.75 years(range 18–32),and the postoperative follow-up ranged from 3 months to 12 months.Preoperatively,their meanaltitude of the palpebral fissure was 4.571±0.616 mm,the mean MRD1 was-0.429±0.616 mm,the mean levator function was 2.43 mm(1–3 mm).Lagophthalmos was observed in all patients in the early postoperative period.The position of eyelids in all patient were normal or basic normal when observed at the third month.Conjunctival prolapse was occured in one eyelid on the first day postoperatively,the prolapsed conjunctiva was resected on the second week postoperatively,during the long-term follow-up,conjunctival prolapse did not recur,without global movement dysfunction.Postoperative follow-up of 3 months,in the series of 14 blepharoptosis in 12 patients,their mean altitude of the palpebral fissure was 7.964±1.100 mm,the mean MRD1was2.964±1.100 mm,mean improvement in MRD1 was 3.393±0.944 mm(t=13.445,P<0.05).In our series of 14 blepharoptosis in 12 patients,nine patients(75%)were satisfied with the cosmetic and functional outcome of the surgery,two patients(16.7%)were abasically satisfied with improvement.In the group of 14 eyelids,one was overcorrected.However,no patients developed exposure keratopathy and corneal ulcer.Conclusion This simple atraumatic technique of conjoint facial sheath(CFS)suspension combined with levator muscle resection is especially suitable and effective for patients with severe congenital blepharoptosis.This technique does not add any tissue and is simple to repeat if necessary.This is a dynamic suspension technique by which CFS is brought forward and sutured to the tarsus,which raises the eyelid.