Study Of Postoperative Visual Acuity For Congenital Ptosis At Different Ages

Purpose: The study aims to describe and analyze the influence of congenital ptosis on the visual function of patients and to analyze the recovery of patients’ visual function after surgery,then make a judgement of the treatment timing of congenital ptosis.Methods: 265 cases of congenital ptosis were studied,the preoperative inquiry and ophthalmic examination were recorded,including visual acuity,refraction,ocular muscle examination,measurements of levator function(LF),upper eyelid margin reflex distance(MRD1)and the affected palpebral fissure height(PFH).Levator muscle resection was used to treat 41 bilateral ptisic cases and 96 unilateral ptosic cases,and the preoperative and postoperative data were compared with each other.Results: Among patients with unilateral ptosis,patients under 3 years had +1.93 DS in average;patients 3.0～4.9 years had +0.56 DS in average;patients 5.0～7.9 years had-0.47 DS in average;patients 8.0 years and over 8.0 years had-2.31 DS in average.Among patients with bilateral ptosis,patients under 3 years had +2.72 DS in average;patients3.0～4.9 years had +1.57 DS in average;patients 5.0～7.9 years had +0.45 DS in average;patients 8.0 years and over 8.0 years had-0.57 DS in average.The incidence of strabismus was 15.22% and the incidence of amblyopia was 39.13% in unilateral cases while the incidence of strabismus was 6.17% and the incidence of amblyopia was 32.10% in bilateral cases.23 patients had improvement in amblyopia during follow-up,8 of 23 patients were under 3 years,13 of 23 patients were 3.0～4.9 years and 2 of 23 patients were 5.0～7.9 years.Among the one-month follow up for unilateral patients,patients under 3 years had 0.20 DS decreased(P<0.01);patients 3.0～4.9 years had 0.04 DS increased(P=0.614);patients 5.0～7.9 years had 0.06 DS increased(P=0.683);patients8.0 years and over 8.0 years had 0.07 DS increased(P=0.130).Among the one-month follow up for bilateral patients,patients under 3 years had 0.08 DS decreased(P=0.416);patients 3.0～4.9 years had 0.06 DS decreased(P=0.062);patients 5.0～7.9 years had0.09 DS decreased(P=0.371);patients 8.0 years and over 8.0 years had 0.13 DS increased(P=0.166).Among the three-month follow up for unilateral patients,patients under 3years had 0.21 DS decreased(P<0.01);patients 3.0～4.9 years had 0.26 DS decreased(P=0.006);patients 5.0～7.9 years had 0.16 DS increased(P=0.193);patients 8.0 years and over 8.0 years had 0.11 DS increased(P=0.066).Among the three-month follow up for bilateral patients,patients under 3 years had 0.25 DS decreased(P=0.030);patients3.0～4.9 years had 0.17 DS decreased(P=0.041);patients 5.0～7.9 years had 0.06 DS decreased(P=0.548);patients 8.0 years and over 8.0 years had 0.17 DS increased(P=0.203).5 patients had improvement in strabismus.The number of patients without significant astigmatism increased from 14 to 24(P=0.043)Conclusion: Congenital ptosis can result in different degrees of refractive error,strabismus and amblyopia,especially for unilateral cases and cases whose visual axis were covered.Bilateral patients’ visual development has had significant difference with general population since 3.0～4.9 years while unilateral patients’ visual development has had significant difference with general population before 3.0 years.For ptosic cases,surgery before 3～5 years is conducive to the recovery of visual fuction.But the supervise of vision should be done earlier for unilateral cases and cases whose visual axis were covered.