Astigmatism Characteristics and Surgical Outcomes in Younger Children With Severe Congenital Ptosis After Frontalis Suspension Surgery

Background: To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery. Methods: : We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children‘s Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure. Results: : Degree of astigmatism in ptotic and fellow eyes was -1.45±0.59 D and -0.66±0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3% and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9% and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8% to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence. Conclusion: Frontalis suspension surgery can effectively and safely correct congenital ptosis in younger patients, which may ameliorate the development of amblyopic astigmatism.