Surgical Interventions for Congenital Ptosis: a Systematic Review and Meta-analysis of 14 Randomized Controlled Trials

Aesthetic Plast Surg. 2023 Oct;47(5):1859-1869. doi: 10.1007/s00266-023-03360-9. Epub 2023 May 5.


Background: Several types of surgeries have been used in the treatment of congenital ptosis, but the optimal methods and materials for this treatment are unknown.

Purpose: The study aims to evaluate the comparative effectiveness and safety of various surgical methods and materials for treatment of congenital ptosis.

Methods: We performed comprehensive searches of five databases, two clinical trial registries and one gray literature database from inception to January 2022 for related trials to include in this study. Meta-analysis was performed to evaluate the effect of surgical methods and materials on the primary outcomes: margin reflex distance 1 (MRD1), palpebral fissure height (PFH), and degree of lagophthalmos; and secondary outcomes: undercorrection, entropion, corneal epithelial defects, wound dehiscence, recurrence, infection, and cosmetic outcomes.

Results: A total of 14 trials evaluating 909 eyes of 657 patients were included in our study. Compared with the levator plication, the frontalis sling significantly increased the MRD1 (MD = - 1.21; 95% CI [- 1.69, - 0.73]), and the levator resection significantly increased the PFH (MD = 1.30; 95% CI [0.27, 2.33]). For the frontalis sling surgical patterns, the fox pentagon was significantly better than the double triangle at improving the degree of lagophthalmos (MD = 0.70; 95% CI [0.32, 1.08]), while the opened pattern provided statistically better cosmetic outcome than the closed frontalis sling. Analysis of surgical material showed that absorbable sutures significantly increased the MRD1 (MD = 1.16; 95% CI [0.60, 1.72]) compared to non-absorbable sutures when used in levator plication; frontalis sling surgeries performed with silicon rods significantly increased the PFH (MD = 0.88; 95% CI [0.29, 1.47]) compared to those performed with Gore-Tex strips, while autogenous fascia lata provided statistically better aesthetic outcome for lid height symmetry and contour.

Conclusion: Different surgical methods and materials appear to affect different aspects of the congenital ptosis treatment outcome.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

Keywords: Congenital ptosis; Surgical intervention; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Blepharoplasty* / methods
  • Blepharoptosis* / congenital
  • Blepharoptosis* / surgery
  • Eyelids / surgery
  • Humans
  • Lagophthalmos*
  • Oculomotor Muscles / surgery
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Treatment Outcome