Treatment of Congenital Ptosis in Infants With Associated Amblyopia Using a Frontalis Muscle Flap Eyelid Reanimation Technique

Aim: Evaluation of the effect of frontalis muscle flap as sling surgery in severe ptosis with poor levator palpebral superioris (LPS) action.Method: Twenty-five eyes of 18 patients with severe congenital ptosis with poor LPS action were studied over a period of two years. It comprised of 13 eyes of 13 patients of severe unilateral congenital ptosis and ten eyes of five patients with ptosis associated with blepharophimosis syndrome. All patients underwent frontalis muscle flap sling surgery and were followed for six months.Result: At final follow up, 88% of patients had a satisfactory result. No patients required re-surgery. Lagophthalmos was the most common complication seen which subsided by six months. The surgical lid elevation was effective without any recurrence or complete failure.Conclusion: Frontalis muscle flap sling surgery is an effective procedure for severe ptosis with poor LPS action.

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Comparative evaluation of conventional and modified frontalis muscle flap advancement techniques in the treatment of severe congenital ptosis: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0246183 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246183

Author(s):

Lei Zhang ◽

Wenjuan Zhai ◽

Lihong Yang ◽

Chunhua Sun ◽

Ye Pan ◽

...

Keyword(s):

Cohort Study ◽

Success Rate ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Muscle Flap ◽

Conventional Group ◽

Angular Deformity ◽

Complication Rates ◽

Congenital Ptosis ◽

Frontalis Muscle

Purpose To introduce a modified frontalis muscle (FM) flap for use in FM flap advancement surgery and compare it with the conventional flap for correcting severe congenital ptosis. Methods This retrospective cohort study included 200 patients (278 eyes) with severe congenital ptosis treated with FM flap advancement at Tianjin Eye Hospital from April 2018 to October 2019. The patients were divided into two groups: 100 patients (138 eyes) in the conventional group and 100 patients (140 eyes) in the modified group. The success and complication rates were evaluated. Results The final success rate was 77.5% (107/138) in the conventional group and 90.0% (126/140) in the modified group (p = 0.005). Undercorrection was observed in 31 eyes (22.5%) in the conventional group and 14 eyes (10%) in the modified group (p = 0.005). In the conventional group, angular deformity of the upper eyelid was observed in 29 eyes (21.0%), FM paralysis in 11 (8.0%), frontal hypoesthesia in 10 (7.2%), severe hematoma in 12 (8.7%), and exposure keratitis in 8 (5.8%); these complications were not observed in the modified group (p <0.001, p <0.001, p = 0.004, p <0.001, p = 0.011, respectively). There were no cases of overcorrection, entropion or ectropion in either group. Conclusion Compared with the conventional FM flap, the modified FM flap in this study yielded a higher success rate with a clear field of vision, mild trauma, and few complications. This technique is simple and convenient for correcting severe congenital ptosis.

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