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.