Outcome of Frontalis Brow Suspension Surgery in Congenital Ptosis –Experience in a Tertiary Eye Care Center in Bangladesh

Objective: to assess functional and cosmetic outcome of frontalis brow suspension surgery with silicon tube in correction of moderate to severe congenital ptosis with poor levator function. Method: it is a prospective interventional study conducted in Ispahani Islamia Eye Institute and Hospital with in period of January 2018 to December 2018 with minimum follow up period of 6 months. Total 44 eyes of 39 patients were included in this study. Detailed history were taken from the entire patient, and then properly evaluated and surgery was done. Pre and postoperative details were properly documented in each case. Results: among 39 patients, 61.5% patients were within 0 to 15 years age group. Rest 38.46% patient were more than 15 years. Among all patients, 53.84% patients were male and 46.15% patients were female with male female ratio 1.16:1. 34 (87.17%) patients had unilateral ptosis while 5 (12.82%) patients had bilateral ptosis. 22(50%)cases came to the hospital with ptosis only and 22 (50%) cases had associated symptoms like refractive error, amblyopia, mono ocular elevation deficiency, hypotropia etc. In all cases frontalis brow suspension were done by silicon tube. Functional outcome were measured by comparing pre and post-operative margin reflex distance 1 (MRD 1). Mean pre-operative MRD1 -2.04 ± 0.56 mm has improved post operatively to +1.90 ± 0.05 mm. Cosmetic success were defined when 3 criteria were met: 1.satisfactory lid contour, 2. satisfactory lid symmetry ( ≤ 2 mm asymmetry in MRD1) and 3.satisfactory lid crease formation. Functional and cosmetic success rate was 93.18 % cases. Only 3 cases had under correction requiring knot revision. Other mild complication was lid edema, mild lagophthalmos, and mild lash ptosis. Post-operative wound infection occurred in 1 case which was successfully treated with systemic antibiotic.