Broad fascia fixation enhances frontalis suspension

PURPOSE: To report the use of a modified frontalis suspension procedure for congenital ptosis patients with minimal to no levator function. METHODS: Retrospective, non-comparative case series of frontalis suspension by 2 surgeons over a 21-year period. RESULTS: Frontalis suspension with broad fascia fixation was performed on 48 eyelids of 25 patients. All patients had visual obscuration due to blepharoptosis with only 0 mm to 2 mm of measurable levator function. Age ranged from 3 to 13 years. Minimum length of follow-up was 6 months (range, 6-174 months). The palpebral fissure was increased in all patients, improving their head position and unmasking their visual axis in primary gaze. Postoperatively, all patients developed transient exposure symptoms. There were no migrations, extrusions, infections, or granulomas. All patients achieved a satisfactory postoperative result based on eyelid position, function, and contour. CONCLUSIONS: This modified frontalis suspension procedure maximizes frontalis muscle recruitment, creating powerful eyelid elevation with stable effect over time. The technique minimizes other procedures' pitfalls and advances in cosmesis are achieved with enhanced eyelid crease formation and adjustable eyelid contour.     

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.     

Long-term results of frontalis suspension using autogenous fascia lata for congenital ptosis in children under 3 years of age

PURPOSE: To evaluate the outcome of frontalis suspension surgery for congenital ptosis using autogenous fascia lata for children under 3 years of age. DESIGN: Retrospective nonrandomized interventional case series. METHODS: This study included nine children (14 eyelids) with severe congenital ptosis aged less than 3 years. All patients underwent frontalis suspension surgery using autogenous fascia lata. Postoperative lid level results, ptosis recurrence, and cosmetic appearance of leg scars were evaluated after the operation. RESULTS: The mean age of the patients was 15.3 months (range, 6 months to 2.5 years) with a mean follow-up period of 41.6 months (range, 18 to 96 months). All children achieved satisfactory cosmetic and functional results, with no postoperative complications such as wound infection, corneal exposure, eyelid contour abnormalities, or ptosis overcorrection. No recurrence of ptosis was encountered. Harvesting was not difficult, and a sufficient amount of material was achieved. There was one patient (11.1%) with a hypertrophied leg scar. CONCLUSIONS: Frontalis suspension using autogenous fascia is proposed as a possible procedure for correcting congenital ptosis in children younger than 3 years of age. It appears to be an effective and feasible treatment for children with poor levator muscle function in this age group.     

重症上睑下垂额肌筋膜瓣悬吊术临床观察

目的:观察额肌筋膜瓣转移悬吊术治疗重度上睑下垂的效果。方法:对52例72眼重度上睑下垂进行额肌筋膜瓣转移悬吊术治疗。结果:本组52例72眼随访1～6a,2例4眼矫正轻度不足,2例4眼重睑轻度不对称,其余均获得满意疗效,上睑弧度及双重睑自然美观,恢复了上睑功能。仅部分病例早期轻度睑裂闭合不全,无暴露性角膜炎等并发症发生。结论:额肌筋膜瓣转移悬吊术是治疗重度上睑下垂最理想的手术方法,手术中的上睑缘位置高低,额肌缝合睑板的位置是手术成功的关键。     

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.     

异体阔筋膜兜带术矫正下睑松弛及外翻

目的:探讨阔筋膜兜带术矫正下睑松弛及外翻的疗效。方法:1994～2001年采用异体阔筋膜兜带术矫正8例下睑松弛或外翻病例,术后随访6～24月。结果:8例患者下睑松弛外翻均得到矫正,无并发症发生。结论:异体阔筋膜兜带术对于麻痹性脸外翻和其他睑松弛外翻矫正术后失败者疗效良好。     

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.     

HIV and banked fascia lata.

Concern over the transmission of communicable diseases through donor tissue has recently increased. Nine hundred and fifty-nine pieces of banked homologous irradiated fascia lata have been distributed to ophthalmic plastic surgeons nationwide over the past 3 years since the establishment of the Wills Eye Hospital Fascia Lata Bank. Safeguards taken against the transmission of disease include strict donor selection; negative antibody testing for human immunodeficiency virus (HIV), rapid plasma reagin (RPR), and hepatitis B surface antigen (HbsAg); heat treatment; and radiation sterilization with 4 million rads of cobalt-60 gamma radiation. To date, no cases have been reported of the transmission of HIV through surgical implantation of banked irradiated homologous fascia lata.     

A randomized clinical trial of two methods of fascia lata suspension in congenital ptosis

PURPOSE: To compare the results of 2 methods of upper eyelid sling placement with autogenous fascia lata in the treatment of congenital ptosis. METHODS: In a randomized clinical trial, patients with congenital upper eyelid ptosis and poor levator function (<4 mm) were randomly assigned to either of 2 methods of upper eyelid sling placement: group A, bitriangular fascia sling (modified Crawford method), and group B, monotriangular fascia sling (modified Fox method). RESULTS: This study included 30 upper eyelids (15 eyelids in each surgical group) of 19 patients (8 unilateral and 11 bilateral cases) with congenital ptosis. Mean increase in eyelid fissure height was 2.7 +/- 2.3 mm in group A and 3.4 +/- 2.2 mm in group B. Change in eyelid fissure in both groups was significant (p < 0.001, paired t test) but the intergroup difference was not (p = 0.4, independent sample t test). Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the 2 groups. No patient experienced recurrent ptosis requiring reoperation in either group. CONCLUSIONS: The monotriangular method of upper eyelid fascia sling placement can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation, and a shorter period of anesthesia.