الفهرس 
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Abstract
Ptosis (drooping of the upper eyelid) is the most common lid malposition in children and the most popular surgically correctable lid disorder. It can be divided into a large group of congenital and a smaller group of acquired ptosis.
The most common cause of congenital ptosis is myogenic due to improper development of the levator muscle (rather than normal muscle fibres, fibrous and adipose tissues are present in the muscle belly), which diminishes the ability of the muscle to contract and relax; thus, the condition is commonly called congenital myogenic ptosis.
The crucial aspects of the congenital ptosis patient’s preoperative care are history taking, complete ocular examination, ptosis assessment and documentation. Mild ptosis is 2 mm or less, moderate ptosis is 3 to 4 mm, and severe ptosis is 4 mm or greater. The levator excursion is the best clinical test to assess the levator function and to determine the required line of surgery. It is documented in millimeters, levator excursion of 8 mm or greater is considered a good function, 5 to 7 mm of excursion is a fair function, and 4 mm or less is a poor function.
The majority of ptosis cases need surgical correction. A successful ptosis surgery should provide a lid that is just below the limbus in the primary position; and in unilateral cases, the repaired ptotic lid should resemble as much as possible the contralateral lid. There are essentially two procedures for congenital ptosis repair whether congenital or acquired: resection of the levator muscle and frontalis suspension.
In congenital ptosis with poor levator function, frontalis suspension has been considered the surgical option of choice. Various sling materials have been used such as autologous fascia lata, silicone rods, e‑polytetrafluoroethylene and non-absorbable suture materials including nylon and polypropylene. However, other surgeons have advocated maximal levator resection in these cases: in order to avoid sling-related complications and to achieve a better outcome in unilateral and amblyopic cases, in which a compensatory frontalis action might be absent
The present study was carried out at the hospital of the Research Institute of Ophthalmology, to compare the outcomes of maximum levator resection with that of frontalis suspension (Fox procedure – open technique) using Gore-Tex and Prolene slings, in the treatment of congenital blepharoptosis with poor levator function. 50 eyes were included and divided into three groups: 15 eyes underwent frontalis suspension using Prolene sutures, 15 eyes underwent frontalis suspension using Gore-Tex and 20 eyes underwent maximum levator muscle resection. The cases were followed up at 1 week, 1 month and 6 months after surgery. Post-operative examination included marginal reflex distance and complications.
In comparison to pre-operative mean values, MRD1 significantly improved in all groups. Nevertheless, these results were the least with Prolene, followed by Gore-Tex, and highest with maximum resection. By the end of the follow up period, mean results of maximum levator resection were significantly higher than that with Gore-Tex (P=0.041) and Prolene (P<0.001). Moreover, mean results of Gore-Tex were significantly higher than Prolene (P=0.021).
Lagophthalmos was inevitable; it was significantly higher in maximum resection group followed by Gore-Tex group, and it lasted for a longer duration in both of the 2 groups compared to the Prolene group. As a result, the incidence of exposure-related corneal complications was the highest in maximum resection group followed by Gore-Tex group, then Prolene group.
We concluded that, compared to frontalis suspension surgery, maximal levator resection is a good option to correct congenital ptosis with poor levator excursion; however, there is a high risk of exposure keratopathy. That’s why the eye surface should be carefully monitored in the first follow-up months, and only patients with intact Bell’s phenomenon are candidates for this surgery. As regarding the suture material used in frontalis suspension, Gore-Tex was superior to Prolene in terms of better lid height, longer effect and lower recurrence rate.