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.

Correction of Lowerlid Entropion by Using Skin-tarsal Fixation Method

For its lowerlid entropion correction, nonsurgical eyelid suture or surgical eyelid suture can be employed. Different types of surgical eyelid suture such as the Hotz method and the Callahan method, are generally performed, but were not sufficient for correcting of entropion. In our hospital we performed modified skin-tarsal fixation on 15 patients, 5 male and 10 female from January 20, 1999 to December 16, 2002. We corrected lower eyelid entropion with the excision of the skin and orbicularis oculi muscle and buried suture of tarsal plate and dermis which is a variant of the Callahan method. All the patients were satisfied with the operation results, and there was no case of recurrence of the lower eyelid pricking the cornea. During the 6 months period after the operation, the lower eyelids slightly turned inward but there was no further progression. The correction was performed excessively, therefore there was no case of recurrence after the operation and the results were satisfactory. There developed a dimple at the suture margin caused by skin contraction but it usually disappeared within 2 months after the operation. To avoid recurrence and to achieve satisfactory results, the orbicularis oculi muscle must be totally resected at the ciliary margin. We resected ciliary as well as pretarsal portion of orbicularis oculi muscle. Also, since most of the recurrences are originated from the medial side, the medial portion of skin flap must be tightly fixed to avoid recurrence and the upper part of the dermis should be fixed tightly to the lower border of the tarsal plate.