Effect of surgical correction of congenital ptosis on amblyopia.

PURPOSE: To determine if amblyopia improves following surgical correction of congenital ptosis.

METHODS

Clinical records from 130 congenital ptosis patients presenting to the Childrens Hospital Los Angeles Department of Ophthalmology between January 1999 and April 2006 were retrospectively reviewed. Patient ages ranged from 2 months to 17 years old. Amblyopia was defined as best-corrected visual acuity of less than 20/40 and greater than 2 Snellen lines of difference between the 2 eyes. In younger patients, amblyopia was defined by a lack of fixation in the ptotic eye compared with the nonptotic one. All patients diagnosed with amblyopia were treated with occlusion therapy.

RESULTS

Of the 130 patients, amblyopia was found in 21.5% (28/130), associated strabismus was found in 16.2% (21/130), and associated anisometropia was found in 14.6% (19/130). There were 50 congenital ptosis patients treated surgically. Of these patients, using an upper age limit of 8 years, 15 patients were diagnosed with preoperative amblyopia (37.5%) reducing to 2 patients (5%, p < 0.005) postoperatively (average follow-up 19.8 months). There were 40 congenital ptosis patients without associated anisometropia or strabismus treated surgically. In this group, using an upper age limit of 8 years, 9 (27%) were diagnosed with preoperative amblyopia reducing to 1 (3%, p < 0.0196) postoperatively (average follow-up 18.1 months). No new cases of amblyopia were diagnosed postoperatively. Comparatively, in the nonsurgical group, amblyopia was present on initial examination in 8.7% (2/23), and was present in 17% (4/23) of these patients at follow-up (mean, 17.2 months).

CONCLUSION

Surgical correction of congenital ptosis may aid in the treatment of amblyopia.