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

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 (MRD 1 ) 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 MRD 1 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, x 2 test). Conclusions: Silicone sling FS has a favourable 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.