Ptosis Repair Using Preserved Fascia Lata with the Modified Direct Tarsal Fixation Technique

PURPOSE: To evaluate the clinical outcome of frontalis sling operation using preserved fascia lata with modified direct tarsal fixation in congenital ptosis patients. METHODS: Forty-seven congenital ptosis patients (60 eyes) who underwent a frontalis sling operation using preserved fascia lata with modified direct tarsal fixation method between March 2001 and December 2008 with a mean follow-up time of 52 months (range, 26 to 122 months) were included in this study. The medical records were reviewed retrospectively. RESULTS: A retrospective chart review was conducted in patients who were diagnosed with congenital ptosis and underwent frontalis suspension surgery using preserved fascia lata with modified direct tarsal fixation from 2001 through 2008 at Dong-A University Hospital. The patients were 34 males and 14 females. The age of the patients ranged from 1 to 18 years with an average age of 4.51 years. At a mean follow-up of 60 months, good final results were achieved in 46 eyes (76.6%), fair in 8 eyes (13.3%), and poor in 6 eyes (10%). The poor results consisted of undercorrection of 1 eye and recurrence in 5 eyes. The accumulative survival rate was 87.2%, with all recurrences occurring within 12 months postoperatively. CONCLUSIONS: Frontalis sling operation by preserved fascia lata with modified direct tarsal fixation appears to be an effective treatment for severe congenital ptosis, showing good long term results.

Frontalis Sling Operation by Fixation of Preserved Fascia Lata to Tarsus in Congenital Blepharoptosis Patients

PURPOSE: To evaluate the efficacy of tarsal fixation of fascia in frontalis sling surgery using preserved fascia lata in congenital ptosis patients. METHODS: The authors retrospectively investigated the surgical results of congenital ptosis patients who underwent frontalis sling procedure using preserved fascia lata with or without tarsal fixation. Thirty-nine patients were included in the group with tarsal fixation of fascia and 43 in the group without tarsal fixation. The average age at operation was 59.3 months in the tarsal fixation group, and 64.7 months in the group without tarsal fixation. We compared the recurrence rates between the two groups using the survival analysis. RESULTS: Recurrence occurred in 13 patients of the tarsal fixation group (33.3%) and in 20 of the group without tarsal fixation (46.5%). The two groups' median survival times from operation to recurrence were 28.4 months and 26.1 months, respectively (p=0.64). CONCLUSIONS: Tarsal fixation of fascia did not have a significant influence on recurrence rates in congenital ptosis patients who underwent a frontalis sling operation using preserved fascia lata.

Frontalis Sling Operation Using Silicone Rod in Congenital Blepharoptosis Patients

PURPOSE: To evaluate the results of frontalis sling operation using silicone rod in congenital ptosis patients. METHODS: The authors retrospectively investigated the surgical results of congenital ptosis patients who underwent frontalis sling operation using silicone rod and were followed up for at least 12 months postoperatively. We compared their results with those of congenital ptosis patients who underwent frontalis sling operation using preserved fascia lata. RESULTS: Twenty nine patients were included in the silicone rod group and 81 in the preserved fascia lata group. The average age at operation was 70.5 months in the silicone rod group, and 62.2 months in the preserved fascia lata group. At 12-month follow-up, good lid height was achieved in 9 patients (31.0%), fair in 17 (58.6%), and poor in 3 (10.4%) among the 29 patients of the silicone rod group. Of the 81 patients with preserved fascia lata, 22 (27.2%) were good, 44 (54.3%) were fair, and 15 (18.5%) were poor at postoperative 12 months. Chronic exposure keratopathy occurred postoperatively in one patient of the preserved fascia lata group and early recurrence due to spontaneous break of silicone rod developed in one patient of the silicone rod group. CONCLUSIONS: At 12-month follow-up, frontalis sling operation using silicone rod showed equal or better results compared with the operation using preserved fascia lata. However, longer follow-up is required to confirm the long-term results of frontalis sling operation using silicone rod.

An Experimental Study of Histological Changes of Scleral Homograft

Transplantation of the scleral homograft was performed with 6 rabbits in order to evaluate its usefulness as a material for frontalis sling operation. Scleral homografts which were surrounded by connective tissue maintained normal scleral architecture until the 12th week of subcutaneous implantation. Under the electronmicroscopic examination, sclenl homografts maintained their proper collagen fiber type I architecture until the 12th week. With these results we considered that homologous scleral shell could be a promising material for frontalis sling operation.