Prediction of postoperative eyelid height after frontalis suspension using autogenous fascia lata for pediatric congenital ptosis

Purpose: To predict eyelid height after frontalis suspension using autogenous fascia lata for congenital ptosis. Design: Retrospective, observational case series. Methods: Eighty eyes of 54 children who underwent frontalis suspension using autogenous fascia lata were included. The amount of intraoperative eyelid lift and the postoperative change in eyelid height were assessed 6 months after surgery by reviews of photographs and medical records. The amount of operative eyelid lift was measured from 2 different baselines, and each amount was compared with the amount of real change in eyelid height after surgery. The difference between those was measured. Results: The postoperative eyelid height stabilized 3 months after surgery. The average amount of operative eyelid lift was 5.91 mm with anesthesia-induced lagophthalmos and 3.51 mm without. The amount of real change in eyelid height after surgery was 3.24 ± 1.14 mm. In less severe ptosis (< 3 mm of lift), an average operative lift of 2.03 mm resulted in 2.53 mm of elevation, whereas in more severe ptosis (< 4 mm of lift), an average operative lift of 3.98 mm resulted in only 3.72 mm of elevation 6 months after surgery. The preoperative palpebral fissure (P =.002) and anesthesia-induced lagophthalmos (P <.001) were significant factors influencing postoperative eyelid height. Conclusions: Postoperative eyelid height may predicted be more accurately by compensating for anesthesia-induced lagophthalmos and adjusting the palpebral fissure to be larger than the desired eyelid height for patients with more severe ptosis.