Outcome of silicone sling frontalis suspension in children with simple congenital and complex ptosis

Daphna Landau Prat; Cindy S Zhao; Meera Ramakrishnan; Karen E Revere; William R Katowitz; James A Katowitz

doi:10.1016/j.jcjo.2023.06.002

Outcome of silicone sling frontalis suspension in children with simple congenital and complex ptosis

Can J Ophthalmol. 2023 Jun 24:S0008-4182(23)00184-9. doi: 10.1016/j.jcjo.2023.06.002. Online ahead of print.

Authors

Daphna Landau Prat¹, Cindy S Zhao², Meera Ramakrishnan², Karen E Revere², William R Katowitz², James A Katowitz²

Affiliations

¹ Division 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.. Electronic address: daphna.landau@gmail.com.
² Division 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.

PMID: 37364855
DOI: 10.1016/j.jcjo.2023.06.002

Abstract

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.