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

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.