We investigated changes in postoperative refractive error after surgery to treat congenital ptosis and the clinical outcomes by surgical method. Methods

The study was retrospective and interventional. We enrolled 73 patients in whom 86 eyes exhibited visual axis-obscuring congenital ptosis. All patients were under 8 years of age, with refractive errors or amblyopia, and underwent maximal levator resection or frontalis sling surgery with fascia lata preservation from January 2008 to January 2018; the minimum follow-up time was 6 months. Visual and surgical outcomes were assessed by reviewing clinical photographs taken before and 1 year after surgery. Refractive error changes were measured at these times. Results

Maximal levator resection was performed on 42 of 86 eyes (48.8%) and frontalis sling surgery with preservation of the fascia lata on 44 eyes, 95.2% and 75.0% of patients, respectively, exhibited good or fair surgical outcomes. The preoperative mean astigmatisms of the ptotic and control eyes of those with unilateral disease did not differ significantly: −0.71 ± 0.85 D for ptotic eyes and −0.66 ± 0.97 D for control eyes. The mean astigmatism increased from −0.71 ± 0.85 D preoperatively to −1.27 ± 1.2 D postoperatively ( p < 0.001). The postoperative MRD1 value correlated with the increase in postoperative astigmatism ( p = 0.022, r = −0.261). Conclusions

Maximal levator resection tended to afford better surgical outcomes than frontalis sling surgery with preservation of the fascia lata in patients with congenital ptosis. Patients in whom the postoperative eyelid position was good tended to exhibit higher refractive errors. Careful examination and treatment are recommended to ensure good visual outcomes.