Анализ эффективности дозированной хирургической резекции леватора верхнего века при лечении врожденного блефароптоза у детей

Abstract

Purpose. Analysis of the clinical efficacy of dosed resection of the upper eyelid’s levator in congenital blepharoptosis in children. Material and methods. 54 children with congenital blepharoptosis (54 eyes) from 4 to 14 years old. It was diagnosed mild form in 4 eyes, moderate form in 11 eyes, and severe form in 29 eyes. In 47 children, blepharoptosis was complicated by obscurative amblyopia of various degrees (87%), in 21 children it was combined with concomitant monolateral strabismus: from +10° to +25° Hirschberg. Method of surgical resection of the upper eyelid’s levator with preservation of Whitnall’s ligament: linear skin incision along the orbito-palpebral fold, followed by isolation of the levator and it’s cutting off from the place of attachment to the tarsal plate by 5–18 mm (depending on the degree of ptosis). Three U-shaped sutures were placed through the levator with their subsequent fixation to the tarsal plate, with resection of the levator and two interrupted sutures on the skin with the capture of the underlying tissues in the areas of the outer and inner corners of the eye. All surgeries went as planned with no complications. Results. On the 10th day, 51 children had the correct position of the upper eyelid, in both eyes it became symmetrical. The palpebral fold was well contoured, it also became symmetrical in both eyes. The excursion of the upper eyelids in this group of children corresponded to that in paired eyes. In two children, the width of the palpebral fissure in the operated eyes turned out to be 1–2 mm less than in the healthy ones, in one child hyper effect of the operation was noted, he underwent reoperation. After 3 years, the initially achieved effect of the operation was preserved in 52 children (96.3%). Conclusion. The use of the technique of surgical resection of the upper eyelid’s levator in the treatment of blepharoptosis of various degrees of severity in children showed high clinical efficacy – 96.3% after 3 years of observation. Key words: congenital blepharoptosis in children, ptosis of upper eyelid, dosed resection of upper eyelid’s levator