Efficacy of Combined Conjoint Fascial Sheath and Levator Muscle Composite Flap Suspension for Congenital Severe Ptosis.

Background: Conjoint fascial sheath (CFS) suspension has been gradually recognized and accepted for the treatment of congenital severe blepharoptosis in recent years. To address the problem of postoperative upper eyelid position regression of only CFS suspension, the authors designed and implemented a CFS combined levator muscle (LM) complex flap, and analyzed the surgical efficacy of CFS with LM (CFS+LM) compared with frontalis myofascial flap (FMF) suspension surgery.

Methods: Patients diagnosed with congenital severe ptosis and LM function of 4 mm or less were enrolled. The patients were assigned to either the CFS+LM group or the FMF group, to compare and statistically analyze the postoperative effects of CFS+LM versus FMF suspension.

Results: Data from 182 patients (220 eyes) were collected in this study, including 89 patients (103 eyes) in the CFS+LM group and 93 patients (117 eyes) in the FMF group. The full correction rate, patient satisfaction, postoperative upper eyelid excursion, and lagophthalmos in the CFS+LM group were significantly better than those in the FMF group. The eyelid retraction rate was significantly higher in the FMF group than in the CFS+LM group. The complication rate in the CFS+LM group was significantly lower than that in the FMF group.

Conclusions: CFS+LM suspension had better outcomes than FMF suspension. Considering that the CFS tissue could be weak in patients younger than 5 years and have poor muscle elasticity in patients with LM function less than or equal to 1 mm, FMF suspension is recommended first. For patients older than 5 years with severe ptosis, CFS+LM suspension is recommended.

Clinical question/level of evidence: Therapeutic, III.