Anisometropia should not be the sole indication for early surgery in congenital ptosis

The timing of pediatric ptosis surgery is often a critical component of care, and anisometropia is frequently cited as an indication for early intervention. In this study, investigators describe changes in refractive error and amblyopia in children undergoing surgery for congenital ptosis.

Study design

The authors performed a retrospective review of 184 pediatric patients (71 eyes) who underwent ptosis surgery and examined mean refractive error change following surgery. Nonoperated eyes served as controls.

Outcomes

The data did not show movement toward normalization of refractive error following ptosis surgery. Interestingly, the authors found that astigmatism significantly worsened following surgery. There were no statistically significant changes in control eyes.

Limitations        

This study was limited by its retrospective design. However, the only prospective study on this subject had a small sample size and did not include patients under the age of 4. A prospective analysis would be ideal to further analyze and definitively answer the authors' clinical question. Additionally, 56 of the original 184 patients were excluded because there was no follow-up with pediatric ophthalmology.

Clinical significance

Based on this study and a review of the literature as discussed by the authors, there is limited evidence that anisometropic amblyopia should be the sole indication for ptosis surgery at a younger age. Performing surgery at a later age allows for better assessment of levator function, lower risk of anesthesia-related complications and a decreased risk of postoperative exposure keratopathy.