Bilateral Frontalis Sling for Surgical Correction of Unilateral and Bilateral Severe Congenital Ptosis with Poor Levator Function

Abstract

Objective: This study evaluated the functional and cosmetic outcomes after bilateral frontalis sling repair using either expanded polytetrafluoroethylene (ePTFE) or silicone rod for unilateral or bilateral severe congenital ptosis with poor levator function. Methods: This was a non-comparative, interventional case series involving 30 patients with unilateral or bilateral severe congenital ptosis who underwent bilateral frontalis sling repair from February 2012 to November 2018. Medical records including pre- and postoperative photographs were reviewed. The functional and cosmetic outcomes were assessed. Results: There were 15 patients with severe congenital ptosis who underwent ePTFE surgery and 15 patients who had silicone rod surgery. Baseline levator function measured was less than 5 mm in all patients. The mean follow-up duration after surgery was 15.6±6.9 months. Satisfactory eyelid contour was observed in all patients (100%). Postoperatively, all had good to excellent primary eyelid position and effective frontalis action on eyelid elevation. Complications included exposure of the silicone sling material after trauma at the brow area (n=1) and recurrence of ptosis (n=2). Conclusion: Bilateral frontalis suspension in patients with severe congenital ptosis, whether bilateral or unilateral, resulted in excellent functional and cosmetic outcomes using ePTFE or silicone rod.

Keywords

• bilateral frontalis sling
• congenital ptosis
• severe ptosis
• expanded polytetrafluoroethylene
• silicon rod