Modified levator muscle complex suspension on treating pediatric blepharoptosis with poor Bell’s phenomenon

PurposeTo evaluate the surgical outcomes of pediatric congenital blepharoptosis with poor Bell’s phenomenon (BP) treated with modified levator muscle complex suspension.MethodsForty-two pediatric congenital blepharoptosis patients with poor BP were treated with modified levator muscle complex suspension, and their major surgical outcomes such as marginal reflex distance1 (MRD1), palpebral fissure height (PFH), and postoperative lagophthalmos were retrospectively reviewed.ResultsThe mean follow-up was 10.28 ± 9.89 months (range 3–32 Months). Surgical success was achieved in 54 (87.1%) of 62 eyelids at the final visit, including excellent results in 46 (74.2%) eyelids, good results in 8 (12.9%) eyelids, and poor results in 8 (12.9%) eyelids, respectively. The postoperative PFH of affected eyes (7.97 ± 1.47 mm) was significantly improved compared with that before surgery (3.58 ± 1.31 mm). The mean MRD1 was improved from − 1.48 ± 1.36 mm before surgery to 2.94 ± 1.46 mm after surgery. The postoperative MRD1 was ≥ 3 mm in 46 eyelids and < 3 mm in 16 eyelids. The mean lagophthalmos was 1.42 ± 1.20 mm 3 months after surgery. All of the patients presented complete blink postoperatively. Postoperative complications were rarely observed during follow-up. No patient had exposure keratitis, but blepharoptosis recurred in 6 patients (8 eyelids). All patients had satisfactory eyelid symmetry and contour. No complications were observed until the last visit.ConclusionsThe modified method results complete blink, mild, and quick recovery of lagophthalmos, flexible eyelid motility, stable ocular surface, and it is simple to perform with few complications and a low recurrence rate at 12.9%, which is worth to wide application on poor Bell’s phenomenon blepharoptosis.

目的 评估改良提上睑肌复合体悬吊术治疗贝尔现象（BP）不良的儿童先天性上睑下垂的手术效果。 方法 对42例贝尔现象不良的儿童先天性上睑下垂患者采用改良提上睑肌复合体悬吊术治疗，回顾性分析其主要手术效果，如边缘反射距离1（MRD1）、睑裂高度（PFH）和术后眼睑闭合不全情况。 结果 平均随访时间为10.28±9.89个月（范围3 - 32个月）。末次随访时，62只眼睑中有54只（87.1%）手术成功，其中46只眼睑（74.2%）效果优，8只眼睑（12.9%）效果良，8只眼睑（12.9%）效果差。患眼术后睑裂高度（7.97±1.47mm）较术前（3.58±1.31mm）显著改善。平均MRD1从术前的-1.48±1.36mm提高到术后的2.94±1.46mm。术后46只眼睑的MRD1≥3mm，16只眼睑＜3mm。术后3个月平均眼睑闭合不全为1.42±1.20mm。所有患者术后均能完全眨眼。随访期间很少观察到术后并发症。无患者发生暴露性角膜炎，但有6例患者（8只眼睑）上睑下垂复发。所有患者眼睑对称性和轮廓均令人满意。直至末次随访未观察到并发症。 结论 改良方法可使患者完全眨眼，眼睑闭合不全恢复轻微且迅速，眼睑运动灵活，眼表稳定，操作简单，并发症少，复发率低（12.9%），值得在贝尔现象不良的上睑下垂中广泛应用。