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.

Preserved Fascia Lata Transplantation for Implant Plate Exposure after Ahmed Glaucoma Valve Implant Surgery: One Case

We report one case of implant plate exposure after Ahmed valve implantation, treated with preserved fascia lata transplantation. Exposure of implant occurred in 47-year-old patient with Ahmed glaucoma valve implantation. She was treated with preserved fascia lata graft and amniotic membrane transplantation. No recurrent implant plate exposure has been found since then. Intraocular pressure has been maintained well for 3 months of follow-up. In cases of implant plate exposure, additional preserved fascia lata graft and amniotic membrane transplantation can improve surgical success.

Congenital Ptosis Repair by Preserved Fascia Lata with Direct Tarsal and Frontalis Fixation

PURPOSE: To investigate the outcome of frontalis suspension surgery congenital blepharoptosis with poor levator palpebral muscle function using preserved fascia lata with direct tarsal and frontalis fixation method. METHODS: Twelve congenital ptosis patients (fourteen eyes) who underwent frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method between July 1999 and June 2002 with the mean follow-up time of 54.8 months (31 months~78 months) included. And the postoperative results were obtained from medical records retrospectively. RESULTS: The desired lid height was achieved in eight out of twelve patients (71.4%) after surgery. In four patients (4 eyes) (28.6%), adjustment was required due to under-correction within one month postoperatively. At a mean follow-up period of 54.8 months, all twelve patients had good final results with no postoperative complications. CONCLUSIONS: Frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method provided cosmetically pleasing results with a low rate of ptosis recurrence and complication related to procedures. This method using preserved facia lata could be considered as alternative to the use of autogenous facia lata for the repair of ptosis.

Congenital Ptosis Repair by Preserved Fascia Lata with Direct Tarsal and Frontalis Fixation

PURPOSE: To investigate the outcome of frontalis suspension surgery congenital blepharoptosis with poor levator palpebral muscle function using preserved fascia lata with direct tarsal and frontalis fixation method. METHODS: Twelve congenital ptosis patients (fourteen eyes) who underwent frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method between July 1999 and June 2002 with the mean follow-up time of 54.8 months (31 months~78 months) included. And the postoperative results were obtained from medical records retrospectively. RESULTS: The desired lid height was achieved in eight out of twelve patients (71.4%) after surgery. In four patients (4 eyes) (28.6%), adjustment was required due to under-correction within one month postoperatively. At a mean follow-up period of 54.8 months, all twelve patients had good final results with no postoperative complications. CONCLUSIONS: Frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method provided cosmetically pleasing results with a low rate of ptosis recurrence and complication related to procedures. This method using preserved facia lata could be considered as alternative to the use of autogenous facia lata for the repair of ptosis.

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.

The Frontalis Sling Operation Using Preserved Fascia Lata: Modified Crawford Technique

PURPOSE: For the correction of ptosis with very poor levator function, frontalis sling operation with various materials has been used. The purpose of this study was to evaluate the effect of the modified Crawford technique using preserved fascia lata. METHODS: The photographs and charts of 46 patients who underwent frontalis sling operation using preserved fascia lata from June 2001 to February 2004 at our hospital were retrospectively reviewed. The eyelid crease approach was used with the suturing of the sling material directly to the tarsus. RESULTS: The patients were 27 males and 19 females. There were 20 (44%) unilateral cases and 26 (56%) bilateral cases. The age of the patients ranged from 1 to 65 years at the time of surgery, with an average age of 8.3 years. The success rate was 93% (43/46 patients) for a mean postoperative follow-up of 9 months (range 4~26 months). The complications consisted of one case of overcorrection and 2 cases of undercorrection. Knot exposure occurred in 2 cases. CONCLUSIONS: The modified Crawford technique using preserved fascia lata appears to be an effective treatment for severe ptosis. The lid crease formation provides good cosmetic results and the direct suturing of the preserved fascia lata to the tarsus prevents its migration.

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.

Frontalis Suspension Using Preserved Fascia Lata for Severe Congenital Ptosis Under 2 years of Age

PURPOSE: To investigate the effect of frontalis sling operation with preserved fascia lata before 2 years of age when amblyopia has existed or is suspiscious. METHODS: We reviewed the medical charts of ptosis patients who undergone frontalis sling with preserved fascia lata before 2 years of age from December 1994 through February 2000. Thirty four patients was included. RESULTS: There were 21 men and 13 women with ages ranging from 5 to 23 months(mean, 13.4 months). With a mean follow-up of 22 months(range 6-60months), 30 patients(88%) achieved normal or near normal eyelid position. Four slings eventually failed, requiring repeat procedure with autogenous fascia lata(2 cases) or preserved fascia lata(1 case). Three patients achieved good results. CONCLUSIONS: Our findings suggest that the frontalis sling using preserved fasica lata has good potential for ptosis management in children before 2 years of age

Frontalis Sling Operation Using Preserved Fascia Lata

In this prospective study, 208 cases of ptosis were repaired using dried preserved fascia lata as suspension material for frontalis sling procedure during 1990 to 1996. The average age at operation was 9.2 years with the range of 2 months to 56 years. One hundred forty one patients (91.0%) of the 155 patients with follow-up of more than 3 months and 99 (90.8%) of the 109 patients with follow-up of more than 6 months showed satisfactory results respectively. Among 12 unsatisfactory cases six patients underwent reoperation and achieved satisfactory results. Exposure keratitis was the most common complication (39.4%)but most of them were transient. The authors report frontalis sling operation using preserved fascia lata with 96.3% of success rate with few complications.