Two different techniques for frontalis suspension using Gore-Tex to treat severe congenital ptosis

Severe congenital ptosis is commonly associated with poor levator function. This study compares the functional and cosmetic outcomes of open versus closed frontalis sling using Gore-Tex in the treatment of such conditions. Randomized interventional comparative case series of 20 eyes of 13 patients with severe congenital ptosis with levator excursion < 4 mm. Patients were treated by frontalis suspension using Gore-Tex string sutures either through a skin crease incision (group 1) or supraciliary incisions (group II). Mean age was 5.10 +/- 3.10 years in group I and 7.30 +/- 4.47 years in group II. Ptosis was unilateral in six patients and bilateral in seven patients. Following surgery, there was a statistically significant improvement in the palpebral fissure width (PFW) and marginal reflex distance (MRD) in both groups (p value 0.001) with better functional outcome in group II (closed approach). The cosmetic results were better in group I (open approach). The mean operative time in group II was 18.1 +/- 2.4 min, which was significantly shorter than group I (30.2 +/- 3.1 min). No recurrence or grave complications were encountered during follow-up. Gore-Tex is a useful sling material for correction of severe congenital ptosis due to poor frontalis action. Open transcrease approach is recommended in absence of lid crease whereas closed approach is better used in cases with preserved crease due to its superior functional outcome.