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Silicone sling frontalis suspension for congenital ptosis: Outcome of 174 consecutive cases
Daphna Landau Prat1,2,3,4, Meera Ramakrishnan1,2, Cindy Zhao1,2
1Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Frontalis suspension using silicone slings is effective for congenital ptosis in children, with two-thirds achieving favorable outcomes. Repeat surgery is an option for cases that do not improve initially.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Frontalis suspension (FS) is a primary surgical treatment for congenital ptosis with poor levator muscle function.
- This study evaluates the efficacy of a specific FS technique using a double triangle configuration of silicone slings in pediatric patients.
Purpose of the Study:
- To assess the surgical outcomes of frontalis suspension with double triangle silicone slings in children with congenital ptosis.
- To determine the improvement in eyelid height, reduction in asymmetry, and reoperation rates.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing FS for simple myogenic congenital ptosis from 2009-2020.
- Measurements of margin reflex distance (MRD1) were taken pre- and post-operatively using clinical photographs and ImageJ software.
- Key outcomes included eyelid height improvement, asymmetry reduction, and reoperation rates.
Main Results:
- 139 patients (174 eyes) were analyzed, with a mean follow-up of 32 months.
- Average MRD1 improvement was 1.5 mm, with a final mean MRD1 of 2.1 mm in patients not requiring a second procedure.
- Eyelid asymmetry improved significantly (p < 0.001), and 34% of patients required repeat surgery.
Conclusions:
- Double triangle silicone sling frontalis suspension shows favorable outcomes in approximately two-thirds of pediatric patients with simple myogenic congenital ptosis.
- Failed FS cases can be successfully managed with a secondary repair, utilizing autogenous fascia lata or an additional silicone sling.
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 (2009-2020). Each silicone sling was secured by simple knots. Pre- and post-operative margin reflex distance (MRD1 ) 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 MRD1 improved by an average of 1.5 mm. The final MRD1 in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD1 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.
