Surgical management of moderate and severe Marcus-Gunn syndrome

Objective To evaluate the efficacy of surgery for Marcus- Gunn syndrome with levator excision and frontalis suspension with EPTFE sutures. Methods This was a retrospective cases series study. Forty- nine patients with Marcus- Gunn syndrome who were diagnosed between 2013 and 2014 in Beijing Children's Hospital were enrolled in this study. The age range was 18 months to 13 years and patients were followed for 10 to 12 months. Twenty-seven(55%) patients had moderate Marcus-Gunn syndrome and 22(45%) had the severe syndrome,while 19(39%) patients had moderate ptosis and 30(61%) had severe ptosis. All patients underwent segmental excision of the levator aponeurosis combined with frontalis suspension with EPTFE sutures on the affected eye. Data were analyzed using Analysis of Variance and chi- square test. Results Surgical success was achieved in 46 cases(94%), but one case still had the jaw winking phenomenon (3 mm). Thirty one cases (63%) increase ≥6 mm, 17 cases (35%) increase 3~5 mm, and 1 cases (2%) recur after 3 months. Complications were found in 13 eyes: 4 eyes had exposure keratitis, 3 eyes had a conjunctival tear, 2 eyes had a recurrence, 2 eyes had trichiasis, 1 eye had repulsion, and 1 eye was faulty. Conclusion Levator excision combined with frontalis suspension with EPTFE were effective in the treatment of Marcus-Gunn syndrome. Key words: Child; Blepharoptosis; Blepharoplasty; Marcus- Gunn syndrome; Frontalis suspension with EPTFE