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Outcome of silicone sling frontalis suspension in children with simple congenital and complex ptosis
Daphna Landau Prat1, Cindy S Zhao2, Meera Ramakrishnan2
1Division of Ophthalmology, Children's Hospital of Philadelphia and the Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.; Division of Ophthalmology, Goldschleger Eye Institute and the Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel..
Insights
Silicone sling frontalis suspension surgery offers similar favorable outcomes for both simple and complex pediatric ptosis cases. Repeat surgery rates were comparable, though younger children required more frequent reoperations.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Strabismus Surgery
Background:
- Congenital ptosis, a condition causing drooping eyelids in children, requires surgical correction.
- Frontalis suspension (FS) surgery using silicone slings is a common treatment for pediatric ptosis.
- Differentiating outcomes between simple and complex congenital ptosis is crucial for surgical planning.
Purpose of the Study:
- To compare the efficacy of silicone sling frontalis suspension (FS) surgery in pediatric patients with simple congenital ptosis versus complex congenital ptosis.
- To evaluate differences in eyelid height improvement and reoperation rates between the two groups.
Main Methods:
- A retrospective cohort study included pediatric patients who underwent silicone sling FS surgery.
- Patients were categorized into simple and complex congenital ptosis groups based on etiology.
- Pre- and postoperative margin-to-reflex distance (MRD1) measurements were analyzed to assess eyelid height improvement.
Main Results:
- The mean MRD1 improved by 1.6 mm in both simple and complex ptosis groups.
- Repeat ptosis correction rates were similar between the simple (29%) and complex (29%) groups.
- Children under 3 years old exhibited higher rates of repeat ptosis repair compared to older children.
Conclusions:
- Silicone sling FS surgery demonstrates a favorable outcome in approximately 70% of pediatric patients with congenital ptosis.
- Eyelid height improvement and reoperation rates were comparable between simple and complex ptosis cases.
- The study suggests that silicone sling FS is an effective surgical option for both simple and complex pediatric ptosis, with similar outcomes despite varying disease complexity.
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 (MRD1) 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 MRD1 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, χ2 test).
Conclusions:
Silicone sling FS has a favourable 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.
