The Mersilene mesh sling--a new concept in ptosis surgery.

The use of a Mersilene mesh sling in brow suspension ptosis surgery is presented. Seventeen cases of severe blepharoptosis have been treated by means of this sling with favourable results. Materials used in brow suspension procedures are categorised and discussed, and it is concluded that the Mersilene sling is an alternative to those currently available for the management of severe blepharoptosis requiring brow suspension surgery.     

Functional results and complications of Mersilene mesh use for frontalis suspension ptosis surgery

AIMS: To assess the functional results and complications of Mersilene (polyester) mesh frontalis sling suspension to correct poor levator function ptosis. METHODS: Retrospective case series. 32 eyelids of 20 patients (12 children and eight adults). RESULTS: Follow up 1-69 months (mean 32). CHILDREN: eight patients had bilateral and four unilateral surgery (20 eyelids). Good long term functional results were achieved in 73% (8/11 children) and 77% (14/18) eyelids. Two children had early postoperative wound infection requiring removal of mesh in one; the other was lost to follow up following medical treatment. ADULTS: four patients had bilateral and four unilateral surgery (12 eyelids). Good long term functional results were achieved in 75% (6/8 patients, 9/12 eyelids). One postoperative wound infection and one mesh exposure were treated definitively by surgical excision of mesh. CONCLUSION: Mersilene mesh provides good functional results but up to 20% of patients have early soft tissue complications. Other materials such as monofilament suture or autogenous fascia lata should be considered.     

Mersilene mesh brow suspension: efficiency and complications.

The use of the Mersilene mesh sling brow suspension procedure for the correction of severe blepharoptosis in 76 lids of 54 patients is presented. After a median follow up of 20 months functional and cosmetic results and complications were evaluated. The method is considered to be an alternative for those cases not primarily suitable for autogenous fascia lata brow suspension.     

Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants

PURPOSE: To compare Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants used in primary enucleation. METHODS: In a prospective, randomized, interventional comparative case series, 60 eyes from 60 consecutive patients were included and randomly allocated for primary enucleation and either Mersilene mesh-wrapped hydroxyapatite (MHA) orbital implant (30 cases, 50%) or sclera-wrapped hydroxyapatite (SHA) orbital implant (30 cases, 50%) under general anesthesia. Complete socket examination was performed at 1 week, 1 month, and then every 3 months after surgery. RESULTS: Mean age was not significantly different (P = 0.08) between patients with MHA (36.43 years) and SHA (28.50 years) orbital implants. The most common cause of enucleation was trauma in both groups (P = 0.09). Patients with MHA had significantly (P = 0.005) longer follow-up time (mean, 11.40 months) than those with SHA (mean, 9.40 months). No exposure was found at last follow-up in the MHA group, but one patient in the SHA group had a small exposure (1 x 1 mm) 1 month after surgery that was conservatively treated. There were no significant postoperative soft tissue complications in either group. CONCLUSIONS: Sclera and Mersilene mesh could be used as a wrapping material for hydroxyapatite orbital implants without significant complications. Absence of disease transmission, low cost, and availability are the main advantages of Mersilene mesh.     

Management of Mersilene mesh chronic eyelid complications: a systematic approach

BACKGROUND: Mersilene mesh (polyester fibre) is commonly used in ptosis surgery for frontalis suspension as it is readily available and cheap. Management of extrusion can be challenging. We report three cases of extrusion where extremely thick mesh or extremely thin tissue may have contributed to the extrusion. METHODS: Retrospective case note study of three adult patients who developed chronic mesh extrusion. RESULTS: Extrusion and chronic infection occurred 5-12 months after surgery. Despite systemic antibiotics, all three patients required surgical excision of mesh from the eyelid up to the brow, which was curative. CONCLUSION: These cases illustrate the need for a systematic approach and the need in some cases to excise the mesh to prevent recurrent infection.     

Long-term follow-up of hyperopic laser in situ keratomileusis correction using the Star S2 excimer laser

PURPOSE: To prospectively evaluate the safety, efficacy, predictability, and long-term stability of hyperopic laser in situ keratomileusis (LASIK) using the Star S2 excimer laser (Visx). SETTING: Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA. METHODS: This study evaluated 41 eyes of 27 patients who had LASIK for the correction of spherical hyperopia. Patients were divided into 3 groups based on preoperative cycloplegic refraction: low hyperopia (less than +2.00 diopters [D]), medium hyperopia (+2.00 to +4.00 D), and high hyperopia (more than +4.00 D). RESULTS: In all eyes, the mean preoperative spherical equivalent (SE) was +2.53 D (range +0.75 to +5.25 D) and the mean attempted SE was +2.58 D (range +0.75 to +5.25 D). At the last visit (mean 5.29 years), the mean SE was +0.44 D +/- 0.69 (SD) in the low hyperopia group, +0.58 +/- 0.56 D in the medium hyperopia group, and +0.59 +/- 1.18 D in the high hyperopia group. The percentage of eyes within +/-1.00 D of emmetropia was 82.4%, 75.0%, and 66.7%, respectively (68.9% overall). The uncorrected visual acuity was 20/40 or better in 100% of eyes in the low hyperopia group, 91.7% in the medium hyperopia group, and 66.7% in the high hyperopia group (87.8% overall). The hyperopic shift between 1 year and the last visit was +0.18 D, +0.30 D, and +0.55 D, respectively (+0.40 D overall; range -1.25 to +2.63 D). CONCLUSIONS: Hyperopic LASIK using the Star S2 excimer laser was safe, effective, and predictable for hyperopia up to +4.10 D (mean of high group). A mild regression of the refractive effect was seen over the 5-year follow-up.     

Adjustable sutures for the correction of adult-acquired ptosis

A modified technique for the correction of adult-acquired ptosis has been developed. This method allows the surgeon to make minor adjustments to lid level and contour 1-2 days postoperatively. The technique permits the surgeon to set the lid level without having to deal with many of the variables found at the time of surgery.     

Long-term follow-up study of scleroplasty using autogenous periosteum

Autogenous periosteum was used to reinforce scleral thinning, perforation, or corneoscleral wound dehiscence in four eyes of three patients with necrotizing scleritis or peripheral ulcerative keratitis associated with advanced rheumatoid arthritis. All grafts have remained intact during an average follow-up interval of 36 months (range, 19-52 months). The postoperative visual acuity ranged between 20/30-20/60. Two eyes exhibited age-related macular degeneration, and one eye had an epiretinal membrane postoperatively. No systemic complications occurred following surgery.     

The correction of ptosis with adjustable suture technique

We discuss here the results of a simple technique for the correction of ptosis, performed by us as an alternative to other techniques. The basic principal of this technique is to suspend the ptotic upper eyelid to the frontalis muscle by 3/0 silk sutures passed above the tarsus using a peritoneal needle and to adjust the rima palpebrarum in the post-operative period. This method is simple and easy to perform with few complications.     

Optimised frontal suspension for correction of complicated ptosis

Complicated ptosis can be corrected by frontal suspension with autologous fascia lata. Via an open approach, the fascia is implanted between the brow and the tarsal plate behind the septum. The oblique implantation between the tarsus and the brow preserves the flexibility of elevation, closure and blinking of the upper lid. Additionally, the skin crease is improved by this technique.     

Mersilene mesh as an alternative to autogenous fascia lata in brow suspension.

PURPOSE: To evaluate the outcome and complications of brow suspension surgery for ptosis repair performed with Mersilene mesh as the suspensory material. METHODS: A retrospective review was undertaken of all patients undergoing Mersilene mesh brow suspension surgery during a 9-year period. All patients had undergone the same surgical procedure performed by the same surgeon. Preoperative and postoperative palpebral aperture heights were recorded, and the results were analyzed to provide a mean change in palpebral aperture height. The case records of patients with a poor response to surgery were examined carefully, and possible risk factors for a poor outcome were identified. RESULTS: The mean (95% confidence interval) increase in palpebral aperture height was 1.8 mm (1.2-2.4 mm). Factors associated with a poorer outcome were previous ptosis surgery and Marcus Gunn jaw-winking syndrome. CONCLUSIONS: Mersilene mesh has advantages over other materials for use as a suspensory material in brow suspension surgery, and is associated with a good outcome and low complication rate.     

Congenital ptosis. Long-term results of treatment using lyophilized fascia lata for frontalis suspensions

This report extends a prospective collaborative study published in 1982 of congenital ptosis repair using lyophilized human fascia lata to investigate the permanency of banked human fascia lata. Fifty-six patients are described with a mean postoperative follow-up of 7.2 years and a median follow-up of 8.3 years. Significant recurrence of ptosis was documented in 24 of 56 (43%) patients. New failures continue to be recognized even in the eighth postoperative year. Life table and survival analysis predicts a success rate from frontalis suspension surgery using lyophilized human fascia lata of 90% at 2 to 3 years, 70% at 5 to 6 years, and 50% at 8 to 9 years.