J Cosmet Med.  2019 Jun;3(1):14-18. 10.25056/JCM.2019.3.1.14.

Long-term result of direct frontalis sling with fascia lata in congenital ptosis

• Kim NY
• Ahn HB

• KMID: 2561065
• DOI: http://doi.org/10.25056/JCM.2019.3.1.14

Abstract

Background
Congenital ptosis with poor levator function are very difficult to make good results of functional and cosmetic side. Surgical methods for the correction of congenital ptosis with poor levator function, including frontalis suspension or maximal levator resection, remain controversial. We evaluated the postoperative surgical and cosmetic long-term outcomes after frontalis sling operation with preserved fascia lata for congenital ptosis with poor levator function.
Objective
To evaluate the long-term outcome of asymmetric ptosis with frontalis sling operation preserved fascia lata by modified direct tarsal fixation in congenital ptosis patients.
Methods
A retrospective case series was performed. From January 2000 to December 2018, 53 patients (30 unilateral and 23 bilateral asymmetric ptosis) with 70 eyelids who underwent frontalis sling with preserved fascia lata were included. Six patients underwent levator resection at opposite eye. The surgical results were graded as excellent, good and poor.
Results
The mean age at the time of surgery was 5.2±3.2 years (range, 1-43 years) with a mean follow-up time of 106.6±29.1 months (range, 60-196 months). Satisfactory results (excellent or good result) were obtained in 94.2% of the patients. Patients were divided into two groups based on levator function as follows: 0 to 2 mm (24 cases) and 2.5 to 4.0 mm (46 cases). Preoperative levator function, margin reflex distance-1 and levator dehiscence were not correlated with postoperative surgical outcomes. Complications were exposure keratopathy (8.6%), lidcrease asymmetry (7.1%), overcorrection (5.7%), entropion (5.7%), and eyelash ptosis (2.9%).
Conclusion
Frontalis sling operation by preserved fascia lata with modified direct tarsal fixation is a simple but effective treatment for severe congenital ptosis with poor levator function. And it has good long-term results.

Keyword

congenital ptosis; frontalis sling; ptosis