Surgical treatment and levator muscle protein analysis of congenital ptosis in craniosynostosis: A case-control study

In this study, we compared the differences between children with craniosynostosis and those diagnosed with severe congenital ptosis who received conjoint fascial sheath suspension surgery. This study included 39 children, 19 craniosynostosis children (23 eyes, 10 males, and 9 females), and 20 children (23 eyes, 10 males, and 10 females) in the control group. All the patients were diagnosed with congenital ptosis and underwent conjoint fascial sheath suspension surgery. The levator muscle was analyzed using proteomics. There were no differences in age, margin-to-reflex distance 1, or levator function between the craniosynostosis and control groups. In the craniosynostosis group, there were 2 children (3 eyes) with exposed keratitis at 1 week follow-up. In total, 2133 proteins were identified. To characterize the molecular features, gene oncology and Kyoto Encyclopedia of Genes and Genomes pathway were investigated. Eighteen proteins in the craniosynostosis group were found to be significantly different from those in the control group, including 12 upregulated and 6 downregulated proteins. There were no differences in age, margin-to-reflex distance 1, or levator function between the craniosynostosis and control groups. Protein analysis of the levator muscle revealed differences in gene oncology and molecular functions. Due to exophthalmos in children with craniosynostosis, the suspension should not overcorrect too much to avoid the occurrence of exposed keratitis after surgery.