The preliminary discussion about the infraduction following conjoint fascial sheath suspension.

Background: We discovered severe ptosis patients developed infraduction after conjoint fascial sheath (CFS) suspension, a complication that is associated with this technique. In this article, the causes and outcomes of the infraduction after CFS suspension were systematically analyzed.

Methods: Seventy-four patients with severe ptosis who underwent CFS suspension between February 2020 and June 2021 were reviewed. The palpebral fissure height (PFH), the eyeball position, the infraduction and recovery distance, the eyeball position difference, and the cosmetic results were recorded and analyzed.

Results: Before surgery, the mean PFH, eyeball position, and cosmetic results were 6.33 ± 0.72 mm, 4.68 ± 0.80 mm, and 2.03 ± 0.96, respectively. The eyeball position difference was 0.70 ± 0.41 mm for unilateral ptosis patients and 0.58 ± 0.26 mm for bilateral ptosis patients. Immediately after surgery, the mean PFH, eyeball position, and cosmetic results were 12.73 ± 1.22 mm (P < 0.0001), 3.01 ± 1.19 mm (P < 0.0001), and 5.80 ± 1.53 (P < 0.0001), respectively. The mean infraduction distance was 1.67 ± 1.04 mm. The mean eyeball position difference was 1.67 ± 1.18 mm (P < 0.0001) for unilateral ptosis patients and 0.83 ± 0.52 mm for bilateral ptosis patients. At the last follow-up, the mean PFH, eyeball position, and cosmetic result were 10.46 ± 1.14 mm (P < 0.0001), 4.19 ± 0.74 mm (P < 0.0001), and 8.24 ± 1.36 (P < 0.0001), respectively. The mean infraduction distance was 0.49 ± 0.48 mm, and the mean recovery distance was 1.18 ± 0.90 mm. The mean eyeball position difference was 0.71 ± 0.61 mm for unilateral ptosis patients and 0.49 ± 0.47 mm for bilateral ptosis patients.

Conclusion: The impact on the superior rectus may lead to infraduction after CFS surgery. Patients developed infraduction immediately after surgery and recovered spontaneously.

Level of evidence: IV.