Frontalis flap advancement versus PTFE (Gore-Tex) frontalis sling operations in the management of congenital blepharoptosis.

Objective: To compare the functional and aesthetic outcomes of two surgical techniques used to correct severe congenital ptosis with poor levator function (LF): frontalis muscle (FM) flap advancement and frontalis sling (FS) surgery.

Methods: This prospective interventional randomized comparative study included 42 eyelids of 34 children with severe congenital ptosis and poor LF. The children were randomly divided into two groups, with 21 eyelids of 19 patients undergoing FM flap advancement, and 21 eyelids of 15 patients undergoing FS surgery. The follow-up period was 6 months.

Results: At 6 months' follow-up, both groups showed comparable improvement in margin reflex distance 1 (MRD1) (3 ± 1.7 vs 3 ± 1.5 mm). Eyelid contour was satisfactory in 91% of flap and 76% of sling procedures. Lid crease was satisfactory in 95% of flap and 81% of sling procedures (P = 0.41 and 0.34, resp.). Complications in flaps included hematoma (38%), eyelid "pop" (10%), lash ptosis (10%), and lagophthalmos (5%); in slings, infection (10%). Undercorrection rates and recurrence rates did not differ significantly between flap (24% and 14%, resp.) and sling groups (19% and 24%, resp.).

Conclusions: In our study cohort, FM flap advancement yielded comparable results to those of conventional FS surgeries for correcting congenital ptosis with poor LF in children.