Frontalis Muscle Transfer Technique for Correction of Severe Congenital Blepharoptosis: 11 Years of Observations Based on Frontalis Muscle Function.

Abstract

Frontalis muscle (FM) transfer is utilized for management of severe ptosis. The authors of this study aim to evaluate the long-term outcomes of FM transfer for the correction of severe congenital blepharoptosis with poor levator function in Chinese patients, with particular emphasis on the influence of intraoperative overcorrection (IOC) based on preoperative FM function (FMF). A retrospective analysis was conducted on patients with severe congenital ptosis who underwent surgical correction through frontalis FM transfer at our institution between 2012 and 2023. All patients underwent FM transfer to correct ptosis with or without IOC. Group I (n = 48) included those who underwent IOC (upper eyelid margin 0 to 1 mm above the limbus in bilateral cases, 1 to 2 mm above the normal side in unilateral cases) surgery; Group II (n = 49) included those treated with intraoperative normal correction (INC; upper eyelid margin 1-2 mm below the limbus in bilateral cases, aligned with the normal side in unilateral cases) surgery. Clinical data, including preoperative margin reflex distance 1 (MRD1), preoperative FMF, postoperative MRD1, and degree of lagophthalmos, were evaluated. Patients were followed up postoperatively for a period ranging from 6 months to 6 years. No significant differences were observed in the mean preoperative FMF and MRD1 between groups. Both groups achieved satisfactory results postoperatively. A significant difference was observed in MRD1 improvements between Groups I and II (5.07 ± 1.15 vs 4.43 ± 1.22 mm, respectively; P < .05). The mean postoperative eyelid lagophthalmos was significantly higher (P < .05) in Group I (0.75 ± 0.78 mm) than in Group II (0.37 ± 0.59 mm). Among the 47 eyelids with good preoperative FMF, the mean postoperative lagophthalmos was significantly higher in Group I compared with Group II. In 43 eyelids with poor preoperative FMF, MRD1 improvements differed significantly between groups; however, their postoperative lagophthalmos difference was not significant. For 49 eyelids with fair preoperative FMF, no significant differences were observed in MRD1 improvements and postoperative lagophthalmos measurements between groups. FM transfer is effective for correcting severe blepharoptosis in Chinese patients. IOC benefits postoperative MRD1 improvements; however, it increases the degree of lagophthalmos. Thus, IOC is not recommended for patients with good preoperative FMF but is required for patients with poor preoperative FMF. For image description, please refer to the figure legend and surrounding text.