A maximal levator resection beyond Whitnall’s ligament approach is an effective surgical strategy for severe simple congenital ptosis with poor levator function (LF). These findings were published in Clinical Ophthalmology.

Patient records (N=31) were retrospectively reviewed for all patients diagnosed with simple congenital ptosis with poor LF at Ramathibodi Hospital in Thailand between 2015 and 2019. Maximal levator resection surgery was performed on 38 eyes by a single surgeon. Clinical outcomes through 12 months were assessed.

Most patients were boys (58%) with unilateral disease (77.24%). A total of five procedures were unsuccessful. During surgery, patients who had unsuccessful surgery had a smaller amount of the levator resected (mean, 14.29 vs 18.15 mm; P =.011) but did not differ for preoperative amount of ptosis (mean, 4.72 vs 4.19 mm; P =.242) or preoperative levator function (mean, 2.29 vs 3.16 mm; P =.561), respectively.

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The mean marginal reflex distance-1 (MRD1) at one week after surgery was 3.61±0.27 mm among the successful outcome cohort and was maintained through 12 months at an MRD1 of 3.51±0.17 mm. For the unsuccessful group, 1-week MRD1 was 2.00±0.49 mm (P =.0115), decreasing to 0.57±0.20 mm (P <.0001) at 12 months.

Among all eyes at 12 months, 71.05% had an excellent functional outcome, 10.53% a good outcome, 7.89% a fair outcome, and 10.53% a poor outcome. The cosmetic outcomes were excellent (83.33%), good (4.17%), and poor (12.50%).

The most common surgical outcomes were lagophthalmos (81.58%), disparity of eyelid in downgaze (77.41%), amblyopia (45.16%), corneal astigmatism (31.58%), exposure keratopathy (26.31%), and undercorrection or recurrence of ptosis (18.42%).

This study may have been limited by combining unilateral and bilateral surgeries in the analysis.

This study found that maximal levator resection beyond Whitnall’s ligament was successful for most patients with severe simple congenital ptosis with poor LF. The study authors suggested that additional surgical refinement may more greatly improve patient outcomes.


Wuthisiri W, Peou C, Lekskul A, Chokthaweesak W. Maximal Levator resection beyond whitnall’s ligament in severe simple congenital ptosis with poor levator function. Clin Ophthalmol. 2022;16:441-452. doi:10.2147/OPTH.S340781

This article originally appeared on Ophthalmology Advisor