Surgical Timing Before Age 3 for Congenital Ptosis: Enhancing Refractive Parameters Recovery in Children.

Abstract

Purpose: The aim of this study is to evaluate the impact of congenital ptosis on visual development and observe postoperative refractive parameters recovery patterns between two distinct age groups: children under 3 years and preschool-aged children (3-6 years).

Methods: A cohort study was conducted among 77 patients aged 1 to 6 years diagnosed with severe unilateral congenital simple ptosis at our hospital. Key data points included demographic data, marginal reflex distance 1 (MRD1), refractive status, and best-corrected visual acuity (BCVA). Preoperative refractive data and ocular examination results were compared with corresponding postoperative data.

Results: The prevalence of pathological anisometropia preoperatively was 26.9% for toddlers and 20% for preschoolers. There was a significant difference in preoperative cylinder power between the affected and unaffected eyes (P < 0.01). Among patients aged under 3 years, postoperative difference in spherical equivalent (△SE) showed significant improvement compared to preoperative △SE (P < 0.05). Among patients older than 3 years, there was no significant change in △SE or BCVA. Both age groups showed no significant change in cylinder power.

Conclusion: Severe unilateral congenital ptosis induces pathological anisometropia and astigmatism while depleting hyperopic reserve in pediatric patients. Early surgical intervention before age 3 years effectively enhances the recovery of refractive parameters. The evidence substantiates the requirement for timely surgical correction during the visual system's critical developmental period.

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