Background: Frontalis suspension (FS) is the treatment of choice in congenital ptosis with poor levator function. We report the surgical outcome of FS using a double triangle configuration of silicone slings in children. Methods: A retrospective cohort study of all paediatric patients with simple myogenic congenital ptosis repaired with FS over a 12-year period (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020). Each silicone sling was secured by simple knots. Pre-and post-operative margin reflex distance (MRD 1 ) measurements were determined from clinical photographs using ImageJ Software. Main outcome measures were improvement in eyelid height, eyelid asymmetry, reoperation rate and timing.Results: One hundred and thirty nine patients (174 eyes) were included, with 35 (25%) having bilateral surgery. Mean (±SD) age was 1.4 ± 1.9 years.Mean follow up time was 32 ± 20.5 months. Sixteen patients (11%) had a history of previous ptosis repair surgery. Mean MRD 1 improved by an average of 1.5 mm. The final MRD 1 in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD 1 difference between both eyes in all unilateral cases improved from 2.5 mm preoperatively to 1.2 mm at final visit (p < 0.001). In the 123 cases without a history of previous ptosis surgery, repeat ptosis repair was performed in 37 (30%) patients, 34.9 ± 19.9 months after the initial procedure. Overall, repeat repair was performed in 47 patients (34%).Conclusions: Double triangle silicone sling frontalis suspension has a favourable outcome in two-thirds of paediatric patients with simple myogenic congenital ptosis. Failed cases can be addressed with a second repair, using either autogenous fascia lata or a second silicone sling.

No abstract

Objectives To compare the outcome of silicone sling frontalis suspension (FS) surgery in children with isolated uncomplicated congenital ptosis (IUCP) vs. children with complicated ptosis. Methods A retrospective medical chart review of all pediatric patients who underwent silicone sling FS surgery between 2009–2020 at a single center were included. Patients were divided according to ptosis type: IUCP vs. complicated ptosis. Pre-and post-operative margin-to-reflex distance (MRD1) measurements were determined from clinical photographs. Main outcome measures were differences in improvement in eyelid height, reoperation rate, and timing between the groups. Results Two-hundred and eight children were included: 139 IUCP and 69 complicated cases, 83 females (40%), mean (± SD) age at intervention was 1.9 ± 2.9 years. Complicated cases included: blepharophimosis epicanthus inversus syndrome (n = 35), Marcus Gunn jaw winking (n = 12), oculomotor palsy (n = 8), congenital fibrosis of extraocular muscles (n = 3), chronic progressive external ophthalmoplegia (n = 3), and others. Mean MRD1 improved by an average of 1.6 mm in both groups. Repeat ptosis repair was performed in 50/171 (29%) patients without a history of failed ptosis procedures, and this rate was similar between IUCP and complicated cases. Children under 3 years of age had higher rates of repeat ptosis repair than older children (n = 59/175, 34% vs n = 5/33, 15%, p = 0.03 chi2). Conclusions Silicone sling frontalis suspension has a favorable outcome in 70% of pediatric patients. Preoperative and final MRD1 and reoperation rates were similar between both groups, suggesting that despite the higher complexity in atypical cases, the outcome is similar.