title: Congenital ptosis and blefarophimosis: retrospective analysis of the effectiveness of correction with levator resection and frontalis suspension.
abstract: BACKGROUND
  treatment of congenital ptoses and blepharophimoses relies on levator resections and frontalis suspensions. Several techniques of levator resection have been described in literature, some of them include tarsal resections and resections of the Müller muscle. Nevertheless a gold treatment have not been detected yet. Frontalis suspension is performed when levator muscle is not functional or when ptosis is severe. The suspension could be carried out with several materials: ePTFE, silicon rods, poly-propylene, nylon, braided poliester, but the preferable material is considered the autologous fascia lata.
  
  
  OBJECTIVE
  this study was designate to determine retrospectively if the indications of surgery are correct, considering age, severity of pathology, relapses and complications. An analysis of demographic data and outcomes for each technique is performed.
  
  
  METHODS
  in this study we analyze case series of 33 pediatric patients affected by congenital ptosis and blepharophimosis congenital syndrome, surgically treated from 2000 to 2008 in the ophtalmic pediatric surgery department at the Niguarda Hospital of Milan. A literature review was also performed.
  
  
  RESULTS
  the mean age at presentation was 4.13. The diagnosis was precocious in most cases and often helped by some recognizable clinical signs: compensatory head posture (48.5%), anisometropia (36.4%), astigmatism (48.5%), strabismus (36.4%) and amblyopia (15.2%). Most of patients was treated with frontalis suspension (57.6%) and their age was significatively lower than patients treated with levator resection. No difference about complications and recurrence was reported between the two techniques. Complications and recurrence amount to 39.4%.
  
  
  CONCLUSIONS
  these results are in line with other studies in literature. A precociuos treatment is able to reduce the incidence of amblyopia from 34% to 8%. The choice of the treatment (resection Vs suspension) has to consider the age of the patient, the severity of ptosis and avaibility of fascia lata. Nevertheless no significative difference in outcomes have been demonstrated between the two techniques.
authors.affiliation: Unità di Chirurgia Plastica e Ricostruttiva, IRCCS San Raffaele, Via Olgettina 60, 20132 Milano. riccardo.gazzola@fastwebnet.it
authors.forename: R
authors.initials: R
authors.lastname: Gazzola
authors.forename: E
authors.initials: E
authors.lastname: Piozzi
authors.forename: A L
authors.initials: AL
authors.lastname: Lanfranchi
authors.forename: F W
authors.initials: FW
authors.lastname: Baruffaldi Preis
mesh_terms: D000293:Adolescent; D016569:Blepharophimosis / Q000601:surgery*; D001763:Blepharoptosis / Q000151:congenital* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies