FUNCTIONAL OUTCOMES OF FRONTO-PERIOSTEAL FLAP SUSPENSION IN CONGENITAL PTOSIS: A PROSPECTIVE PILOT STUDY

Abstract

Objective: To evaluate the functional outcomes and complications of fronto-periosteal flap suspension in severe congenital ptosis with poor levator function. Methods: A prospective study was conducted at the Department of Ophthalmology, Hassan II University Hospital, Fez, over 6 months, with institutional ethics approval, in accordance with the Declaration of Helsinki. Six patients (8 eyelids) were included after exclusion of one case of Marcus Gunn phenomenon among seven recruited cases. The primary outcome was the improvement in margin reflex distance 1 (MRD1) between preoperative and postoperative measurements; secondary outcomes included improvement in palpebral fissure height (PFH) and complication rate. Statistical analysis was based on the Wilcoxon signed-rank test for paired series. Results: The cohort included 3 boys and 3 girls (3 to 9 years old), with unilateral ptosis in 4 patients (66.7%) and bilateral in 2 (33.3%). Mean follow-up was 6 months. A significant improvement in MRD1 (+4.62 ± 1.43 mm; p = 0.0078) and palpebral fissure height (+5.25 ± 1.04 mm; p = 0.0078) was observed. A single recurrence (12.5% of eyelids) required surgical revision; no infection, granuloma, or permanent lagophthalmos was reported. Conclusion: The fronto-periosteal flap with preservation of eyelid dynamics constitutes a reliable and effective autologous alternative to conventional frontalis suspension, limiting the risk of complications while ensuring good functional and aesthetic outcomes in patients with severe ptosis and poor levator function. These preliminary results warrant confirmation through multicenter prospective studies with extended follow-up.