Outcome of Silicone Sling Frontalis Suspension in Isolated Uncomplicated Congenital Ptosis vs. Complicated Ptosis

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 (MRD 1 ) 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 chi 2 ). Conclusions Silicone sling frontalis suspension has a favorable outcome in 70% of pediatric patients. Preoperative and final MRD 1 and reoperation rates were similar between both groups, suggesting that despite the higher complexity in atypical cases, the outcome is similar.