Purpose: To compare the results of two different frontalis sling surgery techniques with silicon rod for ptosis: Fox's single pentagon technique and a modification of Crawford's double triangle technique.
Methods: In a randomized clinical trial, 52 eyes of 50 patients with severe ptosis and poor levator function (≤4 mm) were randomly assigned to the Fox group or the modified Crawford group. Cosmetic outcome, functional success, and lagophthalmos were compared.
Results: The patients achieved a fair to good cosmetic outcome by subjective grading and a fair outcome by objective grading in both groups. The intergroup difference was not statistically significant (P > 0.05). However, patients with preoperative lateral droop had better cosmetic outcome in the modified Crawford group. Mean increase in marginal reflex distance 1 (MRD-1) was 4.0 ± 1.7 mm in the Fox group and 3.7 ± 1.1 mm in the modified Crawford group. Change in MRD-1 within groups was significant (P < 0.0001); however, the difference in the groups was not (P = 0.44). The mean lagophthalmos in the Fox group was 1.3 ± 0.7 mm versus 0.6 ± 0.7 mm in the modified Crawford group at final follow-up. This intergroup difference in lagophthalmos was statistically significant (P = 0.001).
Conclusions: Both techniques were effective in reducing the amount of blepharoptosis and achieving a natural appearing cosmetic outcome. In cases with predominant lateral droop, the modified Crawford's technique seems to produce better results, although the small number of cases does not permit statistical comparison.
Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.