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 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.     

Clinical evaluation of refractive changes following brow suspension surgery in pediatric patients with congenital blepharoptosis.

BACKGROUND AND OBJECTIVE: To evaluate the postoperative visual acuity and refractive changes occurring after bilateral frontalis brow suspension surgery in pediatric patients with congenital blepharoptosis. PATIENTS AND METHODS: Twenty-three patients between 4 and 12 years old with severe congenital blepharoptosis (unilateral in 21 cases and bilateral in 2 cases; total of 25 eyes) and poor levator function underwent bilateral frontalis brow suspension surgery by Crawford's double triangle method with 4:0 expanded polytetrafluoroethylene sutures. The non-ptotic eyes (21 eyes) undergoing frontalis brow suspension surgery served as the control group. All patients had best-corrected spectacle visual acuity (BCSVA) of more than 6/9 preoperatively in both eyes. Changes in the postoperative BCSVA, binocularity, relevant refractive parameters, lid position, lagophthalmos, lid lag, and tear break-up time were evaluated in both groups for 12 weeks and appropriate statistical tests were applied. RESULTS: Significant differences were found in the baseline characteristics and the postoperative changes in the eyes with and without ptosis. However, these were found to be transient and did not result in any new cases of amblyopia postoperatively. No complications requiring revision of surgery were seen. CONCLUSIONS: The changes in the BCSVA after frontalis brow suspension surgery are transient. Retinoscopy, manual keratometry, and corneal videokeratoscopy are simple and effective methods to evaluate the sequential refractive changes occurring in these eyes.     

Long-term follow-up of ptosis correction using Mersilene mesh

The preferred operation for correction of severe ptosis with minimal levator function is a brow suspension procedure. Owing to the poorly developed fascia lata in young children, and concerns about the side effects of harvesting fascia, we have, for many years, used synthetic Mersilene mesh as our suspending material. We present our experience with this material over the last 10 years. We have undertaken a retrospective analysis of the case notes of all patients undergoing brow suspension surgery, using Mersilene mesh, from 1990 to 1999. Functional and cosmetic success was recorded with respect to long-term stability. Data from 41 patients (71 lids, 30 bilateral and 11 unilateral procedures) were analysed. The minimum follow-up period was 12 months with a mean of 38.4 months (SD 23.3). We found a long-term stability of ptosis correction in 67/71 (94.4%) procedures (38/41 (92.7%) of patients). Parental satisfaction was achieved in 90.1% (64/71) of procedures or in 85.4% patients (35/41). Four lids (5.4%) of three patients (7.4%) required further surgery. Mersilene mesh is a safe and convenient suspensory material for brow suspension in young children, and provides good long-term results with a low complication rate.     

Blepharoptosis correction with frontalis suspension using a supramid sling: duration of effect

PURPOSE: To investigate the duration of effect after frontalis suspension with a Supramid (S. Jackson, Inc, Alexandria, Virginia) sling. METHOD: We reviewed 81 consecutive patients (40 males, 41 females), aged 6 months to 50 years (mean, 12 years) with upper eyelid blepharoptosis who underwent frontalis suspension with Supramid sling surgery at a major eye center. RESULTS: Fifty patients had unilateral and 31 patients had bilateral blepharoptosis repair. Forty-three (53%) of the 81 patients had postoperative follow-up of 3 to 12 years; all these patients had a recurrence of blepharoptosis to the preoperative level 1 to 18 months postoperatively. CONCLUSION: Blepharoptosis correction with frontalis suspension with Supramid sling has a temporary effect, and use of this procedure for blepharoptosis correction should be discouraged.     

先天性上睑下垂379例治疗体会

目的 应用不同术式治疗先天性上睑下垂,并对手术效果及其并发症进行评价.方法 自2002年6月至2007年10月间,共收治先大性上睑下垂患者379例(460只眼).其中重度上睑下垂300例(381只眼),中度上睑下垂47例(47只眼),轻度上睑下垂32例(32只眼).行阔筋膜悬吊术196例(246只眼),额肌瓣悬吊术104例(135只眼),提上睑肌缩短术47例(47只眼),提上睑肌腱膜折叠术32例(32只眼).结果 术后满意率为94.6%,好转率为5.0%,总有效率为99.6%.其中阔筋膜悬吊术手术满意率为91.9%,额肌瓣悬吊术满意率为95.5%,提上睑肌缩短术满意率为95.7%,提上睑肌腱膜折叠术满意率为96.9%.手术后有50只眼(10.9%)出现各种并发症,主要有额部血肿、暴露性角膜炎、矫正不全和上穹隆结膜脱垂,经相应处理后均好转.结论 对于提上睑肌无力的重度上睑下垂患者,采取阔筋膜悬吊术或额肌瓣悬吊术治疗,术后重睑自然,远期外观效果较好.提上睑肌力较好的轻度上睑下垂患者宜采取提上睑肌手术,术后重睑弧度自然,并发症少,是较理想的治疗方法.     

One medial triangular Tutoplast sling as a frontalis suspension for adult myogenic blepharoptosis

PURPOSE: The treatment of choice for medium to severe blepharoptosis with minimal or no levator function is frontalis suspension with a sling, using a rectangular or rhomboid sling placement technique. We describe the short-term, follow-up results of frontalis suspension surgery for adult myogenic blepharoptosis using Tutoplast, a commercially available fascia lata allograft. METHODS: We conducted a consecutive, interventional case study. All adult (>25 years of age) patients operated for non-traumatic myogenic ptosis during a 1-year period were included. All underwent frontalis suspension using one medial triangular Tutoplast sling. Success was judged according to lid position and complications. RESULTS: Successful surgical results were judged by lid level, lid symmetry and lid contour. During a mean follow-up of 9 months, the success rate was 91% in all three criteria and 100% in at least two out of three. No major complications were observed. The most prevalent minor complication was the need for lubrication treatment in 26% of the operated patients. CONCLUSION: The use of Tutoplast for frontalis suspension in cases of adult myogenic ptosis is safe and has a high success rate in the early postoperative period. Further large-scale studies are necessary to ascertain the longterm results and the applicability of this material to other indications.     

先天性上睑下垂379例治疗体会

目的 应用不同术式治疗先天性上睑下垂,并对手术效果及其并发症进行评价.方法 自2002年6月至2007年10月间,共收治先大性上睑下垂患者379例(460只眼).其中重度上睑下垂300例(381只眼),中度上睑下垂47例(47只眼),轻度上睑下垂32例(32只眼).行阔筋膜悬吊术196例(246只眼),额肌瓣悬吊术104例(135只眼),提上睑肌缩短术47例(47只眼),提上睑肌腱膜折叠术32例(32只眼).结果 术后满意率为94.6%,好转率为5.0%,总有效率为99.6%.其中阔筋膜悬吊术手术满意率为91.9%,额肌瓣悬吊术满意率为95.5%,提上睑肌缩短术满意率为95.7%,提上睑肌腱膜折叠术满意率为96.9%.手术后有50只眼(10.9%)出现各种并发症,主要有额部血肿、暴露性角膜炎、矫正不全和上穹隆结膜脱垂,经相应处理后均好转.结论 对于提上睑肌无力的重度上睑下垂患者,采取阔筋膜悬吊术或额肌瓣悬吊术治疗,术后重睑自然,远期外观效果较好.提上睑肌力较好的轻度上睑下垂患者宜采取提上睑肌手术,术后重睑弧度自然,并发症少,是较理想的治疗方法.     

Blepharoptosis and hypertrophic osteoarthropathy: A case report

A 52-year-old male patient presented to our hospital with a history of secondary hypertrophic osteoarthropathy (HOA) associated with an abdominal neoplasia and blepharoptosis. He had finger clubbing, hyperhidrosis, and hypertrichosis. He also had a recent history of extensive abdominal surgery with a pathology report of myelolipoma. Routine blood work was unremarkable. Upper eyelid reconstruction with blepharoplasty, upper eyelid wedge resection, and brow suspension was performed to address his eyelid concerns. By this case report, we would like to attract notice that the eyelid involvement may be a part of HOA and to emphasize the importance of systemic and pathologic evaluation in failed blepharoptosis surgery.     

网织带额肌悬吊术一期矫正儿童小睑裂综合征

目的:探讨网织带额肌悬吊术联合内眦韧带缩短、内眦成型术一期矫治儿童小睑裂综合征的手术效果。方法:对14例小睑裂综合征患儿行网织带额肌悬吊术联合内眦韧带缩短、Y-V内眦成型术,术后随访1～24mo。结果:小睑裂综合征患儿14例术后垂直睑裂5～9(平均6.67)mm;水平睑裂25～30(平均28.92)mm,双眼内眦距离30～35(平均30.57)mm。矫治效果满意,无严重并发症发生。结论:网织带额肌悬吊术联合内眦韧带缩短、内眦成型术一期矫治儿童小睑裂综合征是可行的。     

额肌瓣悬吊术治疗重度先天性上睑下垂临床观察

目的:探讨额肌瓣悬吊术治疗重度先天性上睑下垂的临床效果。方法:采用额肌瓣悬吊术治疗重度先天性上睑下垂患者22例27眼。并对术后效果进行随访观察。结果:本组22例27眼,随访3～36mo,除1眼矫正不足外,余均取得良好效果。结论:额肌瓣悬吊术适用于治疗重度先天性上睑下垂,效果确切。     

改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂

目的:探讨改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂的有效性。方法:20例(25眼)学龄前儿童先天性重度上睑下垂,采用改良式额肌瓣悬吊术,利用额肌力量提起上睑。结果:术后1～4a上睑缘位于角膜上缘下1mm20眼,2mm5眼,无复发。结论:改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂效果肯定。     

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.     

额肌悬吊术治疗重度先天性上睑下垂的效果分析

目的 探讨在额肌筋膜瓣悬吊术中,行否睑轮匝肌桥瓣对手术效果的影响.方法 分析2003～2006年接受手术治疗的重度先天性上睑下垂患者,随机分为A组(术中做睑轮匝肌桥瓣)与B组(术中未做睑轮匝肌桥瓣),比较两组术后远期效果.结果 术后6个月比较,A组矫正满意42只眼,矫正良好7只眼,矫正不良2只眼;B组矫正满意51只眼,矫正良好6只眼,矫正不良0只眼,经Ridit检验两组差异有统计学意义(P＜0.01).结论 在额肌筋膜瓣悬吊术中,睑轮匝肌桥瓣对手术效果并无至关重要的作用,相反因其术后较多的产生局部粘连,可能使额肌筋膜瓣的活动性受到一定程度的限制.因此,不主张在该手术中采用睑轮匝肌桥瓣的做法.     

儿童重度先天性上睑下垂的手术治疗

目的:探讨涤纶网织带额肌悬吊术对儿童重度先天性上睑下垂的手术治疗效果。方法:对55例74眼儿童重度先天性上睑下垂进行涤纶网织带额肌悬吊术,术后随访时间1～24(平均6.5)mo。术前术后及随访拍摄照片对照。结果:术后达正矫69眼(93%);低矫5眼(7%);无过矫发生。结论:涤纶网织带额肌悬吊术治疗儿童重度先天性上睑下垂是一种安全有效的手术方法。     

重度先天性上睑下垂的手术治疗

目的分析额肌筋膜瓣悬吊术和异体阔筋膜悬吊术矫正重度先天性上睑下垂的优缺点。方法对重度先天性上睑下垂66例87眼进行手术治疗,其中额肌筋膜瓣悬吊术30例45眼,异体阔筋膜悬吊术36例42眼,分析术后上睑下垂矫正效果、上睑弧度、双重睑成形及暴露性角膜炎发生情况。结果额肌筋膜瓣悬吊术取材方便、复发率较低、上睑弧度匀称;阔筋膜悬吊手术简单、重睑形成良好,但取材困难、复发率稍较高。结论额肌筋膜瓣悬吊术和阔筋膜悬吊术均能有效治疗重度先天性上睑下垂,前者无需特殊材料,术后效果较稳定。     

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.     

额肌筋膜瓣悬吊术矫正完全性上睑下垂

目的：重庆探讨及证明对于完全性的上睑下垂治疗,额肌筋膜瓣悬吊术的可行性和可靠性。方法：对我院眼科1997年3月－1999年4月住院的41例,完全性上睑下垂患者,施行额肌筋膜瓣悬吊术,随访约2年,对全部患者进行观察及分析。结果：额肌筋膜瓣悬吊术对于治疗完全性的上睑下垂,可作为上睑下垂矫正术众多选择方法之一。结论：额肌筋膜瓣悬吊术治疗完全性上睑下垂,效果肯定,并有其独特的优势,特别对需要特殊材料支持的手术,尤其如此。     

叉形额肌腱膜悬吊术治疗中度及重度上睑下垂

目的寻求更佳的治疗中度、重度上睑下垂手术方法。方法在手术治疗上睑下垂时，应用叉形额肌腱膜悬吊术、纵向适度劈开额肌腱膜，充分上提上睑，并均衡的分散拈抗力，治疗32例（59眼）中度重度上睑下垂并观察近、远期效果。结果应用叉形额肌腱膜悬吊术治疗，在术后3个月内有不同程度闭合不全，后逐步好转。术后6个月闭合自然、外形美观，无复发现象。结论义形额肌腱膜悬吊术是一种可靠的治疗中度、重度上睑下垂的方法。