The role of Whitnall’s ligament position in the success of levator resection surgery in congenital ptosis
Mansoreh Jamshidian Tehrani1 , Hanie zeidabadi 2 , Mohsen rafizadeh10 *
- Abolfazl kasai
- Mansoor shahriari
Abstract: This study aimed to investigate the role of Whitnall’s ligament position in the success of levator resection
surgery in congenital ptosis.
Methods: It was an interventional case series on patients with congenital ptosis who underwent levator muscle
resection in Farabi Eye Hospital (2020–2022). Patients with incomplete follow-up, a history of trauma, poor Bell’s phenomenon, previous ocular and lid surgeries, poor levator function (≤4mm), and syndromic ptosis or systemic diseases
were excluded. During the surgery, several factors, including the distance between Whitnall’s ligament and the upper
edge of the tarsus (W-distance), the vertical length of the tarsus (T-length), and the amount of levator muscle resection (LMR), were measured. A successful outcome was defned as the inter-eye diference of margin refex distance-1
(MRD1)≤1 and post-op MRD1≥3 OR the inter-eye diference of MRD1≤0.5 with any value of post-op MRD1 in unilateral cases and Postop-MRD1>3 in bilateral cases during the 3-months period.
Results: lts Thirty four eyes of 34 patients were included, and 79.4% of patients achieved successful outcomes. In univariate analysis, Preop-MRD1 and Preop-LF had meaningful negative correlations with the amount of LMR to reach
the successful outcome (p<0.05), which was only meaningful for Preop-LF in multivariable analysis (p<0.05). Noticeably, W-distance had a signifcant positive correlation in univariate and multivariable linear regression (p<0.05).
Conclusion: W-distance can be considered a signifcant new parameter other than Preop-LF infuencing the amount
of levator resection needed to achieve success in levator resection surgery.
