Changes in Postoperative Fissure Height after Frontalis Suspension Using Autogenous Fascia Lata

ABSTRACT

PURPOSE: Most surgeries to correct congenital ptosis in children are performed with the patient under general anesthesia, which makes the postoperative outcome unpredictable. We analyzed the factors influencing postoperative changes in the fissure height of congenital ptosis patients with poor levator function under general anesthesia after frontalis suspension surgery. METHODS: We reviewed the medical charts of 79 congenital ptosis patients with poor levator function (4 mm or less) who underwent frontalis suspension with autogenous fascia lata under general anesthesia between January 2001 and December 2004. We considered lagophthalmos induced by general anesthesia as the baseline lid level, and the lid was elevated in proportion to the amount of ptosis, as assessed by photographic analysis. Photographs were taken and then analyzed using the Scion Map analysis program to measure the fissure height objectively at 1 week, 1 month, and 3 months. RESULTS: The fissure height formed by frontalis suspension surgery increased progressively and stabilized 1 month after the operation. Levator function had no significant effect on postoperative changes in fissure height. However, a more severe preoperative ptosis and a higher lagophthalmos were associated with a relatively smaller increase in adjusted lid height during the follow-up period. CONCLUSIONS: A good postoperative outcome was achieved by adjusting the lid height to a higher level in eyes with higher lagophthalmos. Especially when confronted with the dilemma of how to correct asymmetric ptosis, higher elevation of lid height in eyes with more severe preoperative ptosis and higher lagophthalmos while under (general) anesthesia should be helpful in the prediction of postoperative surgical outcomes.