Long-term Functional and Cosmetic Outcomes after Frontalis Suspension Using Autogenous Fascia Lata for Pediatric Congenital Ptosis

Objective: To assess long-term functional and cosmetic outcomes after frontalis suspension using fascia lata autografts for congenital ptosis in Asian children. Design: Retrospective, observational case series. Participants: Two hundred thirty-nine patients who underwent frontalis suspension using fascia lata autografts from 1998 through 2006 with a minimum of 6 months of follow-up. Methods: Functional success was assessed by review of photographs and medical charts. Cosmetic success was scored by objective analysis of photographs. Main Outcome Measures: Functional success was defined as improvement of eyelid position above the pupillary margin without serious complications. Cosmetic outcomes were assessed in terms of lid contour, symmetry of height bilaterally, and lid crease and were categorized as excellent, good, or poor at 1 month and at 6 months after surgery. Results: The follow-up time ranged from 6 to 144 months (median, 18 months). The functional success rates were 100% at 1 month after surgery and 94% at the last follow-up. In the early postoperative period, 96.7%, 91.6%, and 97.5% of patients showed excellent cosmetic success rates regarding lid contour, symmetry, and lid crease, respectively. However, these rates decreased to 85.4%, 65.7%, and 66.9% at 6 months after surgery, respectively (P<0.001). Similarly, the mean grades for lid contour, symmetry, and crease were lower at 6 months compared with early after surgery (P<0.001). The only cosmetic parameter that differed between unilateral and bilateral patients was symmetry of height at 6 months after surgery. The occurrence of medial eyelash inversion increased from 0.8% at 1 month to 11 % during the postoperative follow-up, and these cases required medial suspension release and strong double lid crease formation. Conclusions: The use of fascia lata autografts for pediatric congenital ptosis resulted in high functional success rates in both the short-term and long-term. In contrast, whereas cosmetic success rates were high in the short-term, they decreased by 6 months after surgery. This deterioration in cosmetic outcome was the result of gradual elevation of lid height, medial inversion of eyelashes, and poor lid creases, possibly resulting from contracture of the grafted fascia lata and the anatomic characteristics of Asian eyelids. FinancialDisclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2009;116:1405-1414 (C) 2009 by the American Academy of Ophthalmology.