INTRODUCTION Congenital ptosis is malpositioning of the eyelids that, when moderate or severe, can negatively affect visual development during its critical period, resulting in amblyopia: diminished visual acuity with no apparent organic cause. Early diagnosis and timely treatment are essential for preventing amblyopia. Congenital ptosis is uncommon but poses a challenge to any ophthalmologist; the only treatment is surgical. Among these patients in Cuba, those with the most complex clinical characteristics are generally referred to the Ramón Pando Ferrer Ophthalmology Institute in Havana.

OBJECTIVE Characterize visual acuity outcomes obtained in patients seen at this Institute who received surgery for simple congenital ptosis using the frontalis sling procedure.

METHOD A descriptive prospective longitudinal study was conducted to describe visual acuity outcomes in 11 patients with a diagnosis of isolated congenital ptosis seen in the Oculoplastic Service of the Ramón Pando Ferrer Ophthalmology Institute between January and July 2009 and operated on using the frontalis sling procedure. The majority exhibited severe visual acuity impairment (0.1–0.5) prior to surgery. Variables employed were age, sex, degree of ptosis, degree of ptosis correction, visual acuity, and complications during surgery and postoperatively.

RESULTS Male patients aged 1–4 years predominated. Visual acuity improved in 100% of patients, to varying degrees. Prior to surgery, 72% had visual acuity of 0.1–0.5. Six months post-surgery, with visual rehabilitation, 90.9% exhibited visual acuity of >0.5. In 81.8% of patients, palpebral ptosis was fully corrected. Complications were minimal: injury to the palpebral tarsus and undercorrection were the most common and did not affect final surgical outcome or interfere with rehabilitation.

CONCLUSIONS Correction of congenital ptosis using the frontalis sling technique yielded satisfactory visual acuity outcomes, contributing to visual rehabilitation of the affected patients.

KEYWORDS Blepharoptosis/congenital, blepharoplasty, frontalis sling, amblyopia, Cuba

ABSTRACT
INTRODUCTION Congenital esotropia is a convergent deviation of the eyes when fixating on an object. It appears during the first six months of life and affects muscle structure and physiology, as well as the relation of the eyes with the environment, retinal relations and neural integration phenomena. Amblyopia develops in 30–50% of those affected. Timely surgery is effective in most cases.

OBJECTIVE Describe surgical results in congenital esotropia cases treated in the Pediatric Ophthalmology and Strabismus Service of the Ramon Pando Ferrer Ophthalmology Institute in Havana between January 2008 and May 2009.

METHODS A descriptive, retrospective study was carried out through review of 127 cases (aged 1–18 years, 55 male and 72 female) operated on for congenital esotropia from January 2008 to May 2009. Variables used were: age at surgery, degree of preoperative amblyopia, type of fixation, refractive error, associated conditions, type of surgery performed and pre- and postoperative deviation angles.

RESULTS The largest number of congenital esotropia cases were found in children <2 years old (38.6%). Before surgery, 37% of cases studied showed mild amblyopia; 22.8% moderate and 12.6% severe; 27.6% did not cooperate with visual acuity testing. With respect to fixation: 91.3% showed central fixation and 8.7% eccentric. Refractive errors found were: mild hyperopia (65.4%), moderate hyperopia (29.1%), and myopia (5.5%). Associated conditions were: overaction of the inferior oblique muscles (48%), latent nystagmus (16.5%), and dissociated vertical deviation (8.7%); no alterations were found in 26.8% of cases. The most frequently used surgical treatment was bilateral medial rectus muscle recession (92.1%). The most common preoperative deviation angle range was 31–40 prism diopters (PD) in 51.9% of patients; the postoperative deviation angle most commonly found after 12 months was <10 PD in 64.6% (orthotropia).

CONCLUSIONS Surgery, most commonly with medial rectus muscle resection, was effective in correcting congenital esotropia.

KEYWORDS Esotropia/congenital; esotropia therapy; oculomotor muscles/surgery; strabismus; squint; amblyopia; vision, binocular; Cuba

The following erratum has been corrected in all versions of this article.