Outcome of silicone sling frontalis suspension in children with simple congenital and complex ptosis.

OBJECTIVE

To compare the outcome of silicone sling frontalis suspension (FS) surgery in children with simple congenital ptosis and children with complex ptosis.

DESIGN

A retrospective cohort study.

PARTICIPANTS

All pediatric patients who underwent silicone sling FS surgery between 2009 and 2020 at a single centre.

METHODS

Patients were divided based on etiology into simple congenital ptosis and complex congenital ptosis. Pre- and postoperative margin-to-reflex distance (MRD) measurements were determined from clinical photographs. Main outcome measures were assessed as differences in improvement in eyelid height and reoperation rate between the groups.

RESULTS

Two-hundred and eight children were included: 139 simple and 69 complex cases, with 83 females (40%). Mean (±SD) age at intervention was 1.9 ± 2.9 years. Complex cases included blepharophimosis epicanthus inversus syndrome (n = 35), Marcus Gunn jaw-winking syndrome (n = 12), oculomotor palsy (n = 8), congenital fibrosis of extraocular muscles (n = 3), chronic progressive external ophthalmoplegia (n = 3), and others. Mean MRD improved by an average of 1.6 mm in both groups. Repeat ptosis correction was performed in 50 of 171 patients (29%) without a history of failed ptosis procedures, and this rate was similar between simple and complex cases. Children under 3 years of age had higher rates of repeat ptosis repair than older children (n = 59 of 175 [34%] vs n = 5 of 33 [15%]; p = 0.03, χ test).

CONCLUSIONS

Silicone sling FS has a favourable outcome in 70% of pediatric patients. Preoperative and final MRD and reoperation rates were similar between both groups, suggesting that despite the higher complexity in atypical cases, the outcome is similar.