Corneal Astigmatism Changes After Ptosis Correction in Two Age Groups of Patients with Congenital Ptosis
Keywords:
congenital ptosis, corneal astigmatism, refractive error, amblyopia, blepharoptosisAbstract
Purpose: To evaluate postoperative corneal astigmatism changes after ptosis correction in groups of young and older patients with congenital ptosis.
Patients and Methods: A prospective cohort study of 28 patients (56 eyes) with congenital ptosis enrolled at Ramathibodi Hospital was performed from April 2018 to June 2019. Within this group of patients there were 6 cases of bilateral congenital ptosis and 22 unilateral cases of congenital ptosis forming a total of 34 individual ptotic eyes for the study. The patients were categorized into two groups: early-age group (aged ≤5 years,) comprising of 14 eyes and older-age group (aged >5 years) comprising of 20 eyes. The preoperative visual acuity, amblyopic status, ptosis severity, and refractive error of both groups were evaluated prior to ptosis correction. All patients underwent ptosis correction with either levator resection or frontalis sling. Following the correction, the refractive error was measured after a follow-up period of at least 6 months. The astigmatism results were classified into three subgroups: with-the-rule, against-the-rule and oblique astigmatism.
Results: The mean age at diagnosis was 8.91 ± 7.05 years. From the study group, amblyopia was found in 13 out of 28 patients (46.4%). The most common type of astigmatism was with-the-rule astigmatism, making up 24 out of 34 ptotic eyes (70.6%). A postoperative astigmatism change of >0.50 diopters was found in 4 out of14 eyes (28.6%) in the early-age group and in 6 out of 20 eyes (30.0%) in the older-age group (Rate ratio, 1.43; 95% CI, 0.34–6.07).
Conclusion: Astigmatism was reduced following ptosis correction, with no statistically significant difference in the amount of reduction between the two age groups. As there is no significant difference, surgical correction can be deferred in patients of all age groups with anisometropic amblyogenic ptosis until appropriate surgical planning is possible.
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