Levator surgery with and without tarsectomy for correction of fair-function congenital ptosis: A randomized controlled trial.

Purpose: The purpose is to compare the functional and cosmetic outcomes of levator resection with tarsoconjunctival mullerectomy (LR plus) versus modified LR (mLR) for correcting congenital ptosis with fair levator function (LF; 4-7 mm).

Methods: In this prospective, randomized, controlled, double-blinded trial, 34 children (aged 6-12 years old) with unilateral congenital ptosis and fair LF were randomized to LR plus (n = 16) or mLR group B (n = 18). Margin-reflex distance 1 (MRD1), LF, lagophthalmos, corneal staining (Miyata grading), eyelid crease, contour, and eyelash angle were assessed postoperatively at 1, 3, 6, and 12 months. Outcomes were graded by an independent observer.

Results: Both groups demonstrated significant postoperative MRD1 improvements. In the LR plus group, MRD1 increased from 0.56 ± 1.09 mm to 3.44 ± 1.15 mm (P < 0.001), and while in the mLR group, it improved from 0.89 ± 1.18 mm to 4.06 ± 0.94 mm (P < 0.001), with no significant intergroup difference. The mLR group showed significantly greater LF improvement at all-time points (P < 0.001), with a 12-month LF of 11.28 ± 2.16 mm versus 7.38 ± 2.09 mm in the LR plus group. The mLR group had less lagophthalmos, corneal staining (early follow-up), and better eyelid contour at 3, 6, and 12 months. Eyelash ptosis was more frequently observed in the LR plus group. Complications occurred in 3 (18.8%) patients in the LR plus (including exposure keratopathy, recurrence, and suture-related corneal abrasion) and in 1 (5.6%) patient in the mLR group (overcorrection).

Conclusion: Both LR plus and mLR are effective for the correction of congenital ptosis with fair LF. However, mLR yielded in greater LF improvement, less postoperative lagophthalmos and corneal complications, and better eyelid contour. Therefore, mLR may be the preferred surgical technique for this condition.