Congenital ptosis repair with a frontalis silicon sling: comparison between Fox's single pentagon technique and a modified Crawford double triangle technique.

PURPOSE: To compare the results of two different frontalis sling surgery techniques with silicon rod for ptosis: Fox's single pentagon technique and a modification of Crawford's double triangle technique.

METHODS: In a randomized clinical trial, 52 eyes of 50 patients with severe ptosis and poor levator function (≤4 mm) were randomly assigned to the Fox group or the modified Crawford group. Cosmetic outcome, functional success, and lagophthalmos were compared.

RESULTS: The patients achieved a fair to good cosmetic outcome by subjective grading and a fair outcome by objective grading in both groups. The intergroup difference was not statistically significant (P > 0.05). However, patients with preoperative lateral droop had better cosmetic outcome in the modified Crawford group. Mean increase in marginal reflex distance 1 (MRD-1) was 4.0 ± 1.7 mm in the Fox group and 3.7 ± 1.1 mm in the modified Crawford group. Change in MRD-1 within groups was significant (P < 0.0001); however, the difference in the groups was not (P = 0.44). The mean lagophthalmos in the Fox group was 1.3 ± 0.7 mm versus 0.6 ± 0.7 mm in the modified Crawford group at final follow-up. This intergroup difference in lagophthalmos was statistically significant (P = 0.001).

CONCLUSIONS: Both techniques were effective in reducing the amount of blepharoptosis and achieving a natural appearing cosmetic outcome. In cases with predominant lateral droop, the modified Crawford's technique seems to produce better results, although the small number of cases does not permit statistical comparison.