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Frontalis sling surgery - pediatric versus adult population: characteristics and outcomes
Roee Arnon1, Mordechai Rosner1,2, Ayelet Priel1,2
1The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, 526601, Israel.
Insights
Frontalis sling surgery outcomes differ between pediatric and adult patients, with adults experiencing more complications like sling extrusion. Previous surgeries increase complication risks, suggesting caution in adult ptosis correction.
Area of Science:
- Ophthalmology
- Surgical Outcomes
- Ptosis Correction
Background:
- Frontalis sling surgery is a common ptosis correction technique for both pediatric and adult patients.
- Understanding population-specific characteristics and outcomes is crucial for optimizing surgical strategies.
Purpose of the Study:
- To compare the characteristics and outcomes of frontalis sling surgery in pediatric versus adult populations.
- To identify factors influencing surgical success and complication rates in different age groups.
Main Methods:
- Retrospective cohort study including patients who underwent frontalis sling surgery (2009-2024).
- Analysis of age, gender, ptosis type, sling type, complications, and re-surgery rates.
- Comparison of pre-operative and post-operative marginal reflex distance 1 (MRD1) between groups.
Main Results:
- Adults had a higher incidence of myogenic ptosis and lower pre-operative MRD1 compared to pediatric patients.
- Adults experienced significantly higher rates of sling extrusion (14% vs. 0%).
- A greater number of prior sling surgeries correlated positively with increased postoperative complications.
Conclusions:
- Frontalis sling surgery exhibits distinct characteristics and outcomes in pediatric and adult populations.
- Adults face higher complication risks, including sling extrusion and dry eye, making it a last resort option.
- Previous surgical history is a significant predictor of postoperative complications in frontalis sling procedures.
Purpose:
Frontalis sling surgery is a common method for ptosis correction for both pediatric and adult populations. This study aims to compare the characteristics and outcomes of this surgery in these two populations.
Methods:
A retrospective cohort study. Patients who underwent frontalis sling surgery between the years 2009 and 2024, with complete medical chart data, and had at least a one-month follow-up period were included. Age, gender, ptosis type, type of sling, complications, and re-surgery were analyzed.
Results:
A total of 62 patients were included, with 41 patients in the pediatric group and 21 patients in the adult group. The mean age was 4.7 ± 5.0 and 46.04 ± 18.33 years old in the pediatric and adult groups, respectively. The most common etiology of ptosis in the pediatric group was simple congenital (70%), while the most common etiology in the adult group was myogenic ptosis due to a systemic condition (47%) (p < 0.001). Baseline pre-operative MRD1 (marginal reflex distance 1) was lower in the adult group compared to the pediatric ( -0.37 ± 1.21 mm vs. 0.36 ± 0.65 mm respectively (t-test, p = 0.04)). However, the mean change in MRD1 (pre-operative to postoperative) was not significantly different for both groups (t-test, p = 0.5). A higher rate of sling extrusion was observed among the adult group (0% of pediatrics vs. 14% of adults, chi-square, p = 0.013). A higher number of previous sling surgeries were found to be positively correlated (r = 0.672) with overall postoperative complications (Pearson correlation. p = 0.006).
Conclusion:
Frontalis sling surgery varies between adult and pediatric patients regarding etiology, preoperative findings, surgical approach, and complications. Adults experienced higher rates of complications such as sling extrusion and dry eye. Moreover, an increased number of previous sling surgeries was associated with a rise in postoperative complications such as suture dehiscence, extrusion, and granuloma formation. Consequently, frontalis sling procedures should be regarded as a last resort for ptosis correction in adults due to the elevated risk of complications.
