Clinical Significance of Whitnall Ligament Structure

Study Overview
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Brief Summary
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Prospective clincal study to relate the structure of Whitnall ligament in cases of congenital ptosis to the severety of ptosis and the postoperative results.

Detailed Description
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The study will be a prospective obsevational study. It will include patients (2-16 years old) who will undergo levator resection for simple congenital ptosis correction in Ophthalmology Department of Menoufia University Hospital. Patients will be divided into 3 groups, 15 patients in each. Group I for mild ptosis, Group II for moderate ptosis Group 3 for severe ptosis. Exclusion criteria included any patients with previous ptosis or any eyelid surgery and patients with a non congenital ptosis. Patients included in the study well be informed about the research and the surgical maneuver which will be used with full discussion of all details regarding the postoperative follow up and the potential complications. A written consent in Arabic will then be taken from the parents of the patients Preoperative assessment will include Complete ophthalmological examination including; Margin to Reflex Distance 1 (MRD1), Vertical Fissure Height (VFH), Levator function (LF), and eyelid crease shape and position. Intraoperative assessment will include Whitnall ligament structure assessment including: The level (the length from the insertion of the levator aponeurosis to Whitnall's ligament) Shape (definite band-like, weak string, undifferentiated) Tightness. Postoperative assessment will be on scheduled visits at first week, one month, 3 months and 6 months postoperatively and will include MRD1, VFH, LF, and lagophthalmos measurements Results will be documented and tabulated and statistically managed.

Official Title
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Clinical Significance of Whitnall Ligament Structure in Patients With Congenital Ptosis

Conditions
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Congenital Ptosis

Intervention / Treatment
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* Procedure: Levator resection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Congenital ptosis Exclusion Criteria: Previous ptosis surgery Non congenital ptosis

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mild congenital ptosis<br>children with mild congenital ptosis | Procedure: Levator resection<br>* Eyelid crease incision Dissection of the levator aponeurosis to the level of Whitnall ligament. Assessment of the structure of Whitnal ligament. Resection of a calculated part of the aponsurosis. re-attachment of the aponeurosis to the tarsus Incision closure with crease formation<br>|
| Moderate congenital ptosis<br>children with moderate congenital ptosis | Procedure: Levator resection<br>* Eyelid crease incision Dissection of the levator aponeurosis to the level of Whitnall ligament. Assessment of the structure of Whitnal ligament. Resection of a calculated part of the aponsurosis. re-attachment of the aponeurosis to the tarsus Incision closure with crease formation<br>|
| Severe congenital ptosis<br>children with severe congenital ptosis | Procedure: Levator resection<br>* Eyelid crease incision Dissection of the levator aponeurosis to the level of Whitnall ligament. Assessment of the structure of Whitnal ligament. Resection of a calculated part of the aponsurosis. re-attachment of the aponeurosis to the tarsus Incision closure with crease formation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Success of levator resection in relation to structure of Whitnall ligament | Relating the structure of the ligament with the degree of severity of ptosis by studying its position, shape and tightness in all cases during surgery | An average of 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Whitnall ligament, congenital ptosis, levator resection