Ashal Kaisar Pal, Rao Muhammad Arif Khan, Asad Aslam Khan


PURPOSE:  To determine pattern of astigmatism of ptotic eye in cases of simple congenital ptosis by cycloplegic retinoscopy in pediatric population. MATERIALS AND METHODS: Prospective, non-comparative, interventional study. Thirty consecutive eyes with simple congenital ptosis of patients under 12 years of age were included in the study.  Complete ophthalmic examination including   cycloplegic   retinoscopy was done. Brow suspension with 4/0 proline with standard surgical steps under general anaesthesia was done. All preoperative and post operative data was recorded on standard proforma. Follow up period was 4 months with visits at 1st week, 2nd month and at 4th month. On each visit, complete ocular examination was conducted including recordings of refractive status of both eyes under cycloplegic retinoscopy. Complications were identified and negotiated. Optical optimization incurred when and where required.  RESULTS:  Out of thirty patients, twenty one (70%) were male and nine (30%) were female. Fourteen patients (46.66%) were having simple congenital ptosis in right eye and sixteen (53.33%) in left eye. Fifteen out of thirty (50%) patients had with the rule astigmatism prior to intervention, four out of thirty patients (13.33%) had no astigmatism before surgery and eleven out of thirty(36.66%) had against the rule astigmatism leading to surgery . In all the thirty patients, character of astigmatism remained exactly the same in intensity and axis one week post-operatively as it was before intervention. There were four patients in preoperative zero astigmatism group. All of these four transformed into against the rule astigmatism over four months follow up period. Fifteen out of thirty patients were having with the rule astigmatism before surgery. Five of these developed against the rule astigmatism four months after surgery. In seven, with the rule astigmatism transformed into neutrality of zero astigmatism after four months. Only three patients retained their with the rule astigmatic character through four months after ptosis correction though the intensity of astigmatism got reduced. There were eleven patients having against the rule astigmatism preoperatively. Astigmatism neutralized in only one patient over four months of follow up. All other ten patients retained their against the rule character of astigmatism during this short follow up, though the intensity of astigmatism minimized significantly. CONCLUSION: Against the rule astigmatism dominates in pediatric patients with simple congenital ptosis.

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