Intraocular Lens Power Calculation after Refractive Surgery: A Comparative Analysis of Accuracy and Predictability

PURPOSE: To compare the accuracy of intraocular lens (IOL) power calculation using conventional regression formulae or the American Society of Cataract and Refractive Surgery (ASCRS) IOL power calculator for previous corneal refractive surgery. METHODS: We retrospectively reviewed 96 eyes from 68 patients that had undergone cataract surgery after keratorefractive surgeries. We calculated the formula with two approaches: IOL powers using the ASCRS IOL power calculator and IOL powers using conventional formulae with previous refractive data (Camellin, Jarade, Savini, and clinical history method) or without prior data (0, 2 and, 4 mm total mean power in topography, Wang-Koch-Maloney, Shammas, Seitz, and Maloney). Two conventional IOL formulae (the SRK/T and the Hoffer Q) were calculated with the single K and double K methods. Mean arithmetic refractive error and mean absolute error were calculated at the first postoperative month. RESULTS: In conventional formulae, the Jarade method or the Seitz method, applied in the Hoffer Q formula with the single K or double K method, have the lowest prediction errors. The least prediction error was found in the Shammas-PL method in the ASCRS group. There was no statistically significant difference between the 10 lowest mean absolute error conventional methods, the Shammas-PL method and the Barrett True-K method calculated with using the ASCRS calculator, without using preoperative data. CONCLUSIONS: The Shammas-PL formula and the Barrett True-K formula, calculated with the ASCRS calculator, without using history, were methods comparable to the 10 most accurate conventional formulae. Other methods using the ASCRS calculator show a myopic tendency.

Ocular Surface Squamous Cell Carcinoma with Intraorbital Extension in a Patient with Long-Term Immunosuppression

PURPOSE: To report a case of ocular surface squamous cell carcinoma with intraorbital extension in a patient with renal transplantation and long-term immunosuppressive therapy. CASE SUMMARY: A 59-year-old Korean male presented with a whitish mass in the medial limbus and conjunctiva of the right eye. The patient had undergone renal transplantation 17 years prior due to lupus nephritis and was on systemic immunosuppression with daily prednisolone (10 mg), tacrolimus (5 mg), and mycophenolate sodium (720 mg). The complete excision of the mass was performed and mitomycin C application and amniotic membrane transplantation on the excised area were combined. Histopathological examination revealed the mass was squamous cell carcinoma. There were no abnormal findings on the orbit computed tomography (CT). The patient was additionally treated with topical interferon alpha 2b 6 months postoperatively. One year later, a mass recurred at the same site in the right eye. The complete excision of the mass, mitomycin C application, cryotherapy, and amniotic membrane transplantation were performed. Orbit CT showed a 1.9 cm-sized intraorbital mass involving the medial rectus of the right eye. The orbital exenteration was performed and the intraorbital mass was histologically proven to be squamous cell carcinoma. CONCLUSIONS: Ocular surface squamous neoplasia in patients with renal transplantation and long-term immunosuppressive therapy should be monitored closely for the possibility of orbital invasion.

Surgical Outcome of Primary Pterygium Excision with Conjunctival Autograft

PURPOSE: To investigate the clinical outcomes of primary pterygium excision combined with free conjunctival autograft. METHODS: The medical records of 112 patients (129 eyes) who underwent pterygium excision and free conjunctival autograft for primary pterygium were retrospectively reviewed for recurrence and postoperative complications and the outcomes compared with pterygium excision combined with amniotic membrane transplantation, conjunctival flap, or simple conjunctival closure. Additionally, the surgical outcomes were evaluated in relation to the intraoperative use of mitomycin C. RESULTS: Postoperative recurrences were observed in 3 of 129 eyes (2.3%) that received pterygium excision and free conjunctival autograft, 2 of 10 eyes (20.0%) that received pterygium excision with amniotic membrane transplantation, 1 of 10 eyes (10.0%) that received pterygium excision with conjunctival flap and 1 of 12 eyes (8.3%) that received pterygium excision and simple conjunctival closure. Therefore, the recurrence rate was significantly lower in patients with conjunctival autograft than in those without (p = 0.024, Breslow-Wilcoxon test). Additionally, recurrence was observed in 1 of 10 eyes (10.0%) in patients that underwent pterygium surgery when mitomycin C was used intraoperatively and in 2 of 119 eyes (1.7%) without the use of mitomycin C. CONCLUSIONS: Pterygium excision combined with free conjunctival autograft is an effective and safe surgical procedure to treat primary pterygium.

Transcriptional Analysis of Nod-Like Receptors in a Mouse Model of Experimental Autoimmune Uveitis

PURPOSE: To evaluate the transcription pattern of Nod-like receptors (NLRs), the intracellular sensors, to detect danger signals in murine eyes with experimental autoimmune uveitis (EAU). METHODS: EAU was induced in B6 (C57BL/6) mice by subcutaneous injection of human interphotoreceptor retinoid binding protein and intraperitoneal injection of pertussis toxin. At 1, 2, and 3 weeks post-immunization, the eyeballs were extracted and subjected to histological and molecular assays using real-time reverse transcription polymerase chain reaction. RESULTS: The levels of nucleotide-binding oligomerization domain, Leucine rich Repeat and Pyrin domain 1 (NLRP1), NLRP3, nucleotide-binding oligomerization domain-containing protein 1 (NOD1), and NOD2 transcripts were increased at 2 weeks and gradually reduced thereafter. Notably, NLRP3 showed the highest expression in the eyes with EAU. Similarly, the transcript level of pro-inflammatory cytokine, interleukin-1beta, increased and reached a peak at 2 weeks post-immunization. The retinal structure was severely damaged by inflammation at 3 weeks post-immunization. CONCLUSIONS: Among NLRs, NLRP3 may induce inflammation in eyes after EAU immunization.

Clinicopathological Report of Squamous Cell Carcinoma of Conjunctiva and Cornea in a Patient with AIDS

PURPOSE: To describe the clinical and histopathological findings of corneal and conjunctival squamous cell carcinoma (SCC) in a patient with acquired immune deficiency syndrome (AIDS). CASE SUMMARY: A 45-year-old Korean male who had been diagnosed of AIDS 20 years before presented with vascularized mass in the inferotemporal conjunctiva and in the cornea. The patient underwent an en bloc excisional biopsy of the mass, application of mitomycin C, and repeated cycles of freeze-thaw. Histopathology revealed dysplastic squamous epithelium in the full thickness of epithelial layer. Immunohistochemical staining for proliferation markers showed that the tumor had a high proliferation index: Ki-67 was positive throughout the full epithelial layer, and both p53 and p16 were positive. The patient had an adjuvant chemotherapy with topical interferon alpha 2b (IFNalpha 2b) for 8 months after surgery. CONCLUSIONS: Given the high proliferation index of the tumor in this patient, close observation and combined adjuvant chemotherapy will be required to prevent recurrence in a patient with AIDS.

Clinical Outcomes of Penetrating Keratoplasty in Patients Five Years or Younger

PURPOSE: To investigate the clinical outcomes of primary pediatric keratoplasty. METHODS: Records of patients who underwent penetrating keratoplasty at the age of 5 years or younger were retrospectively reviewed. The survival rates of corneal grafts, postoperative complications, and causes of graft failure were evaluated. RESULTS: A total of 31 penetrating keratoplasties were performed in 29 patients, two of which were bilateral. The mean follow-up period was 78.72 +/- 8.94 months. The overall graft survival rate was 51.61%. The graft survival rate was 77.4% at 6 months, 61.3% at 12 months, 57.5% at 2 years, and 49.5% at 5 years after the surgery (the median survival time, 39.2 months). The main surgical indications included sclerocornea (35.5%), followed by Peter's anomaly (25.8%) and congenital glaucoma (9.7%). There were significant differences in graft survival time among the surgical indications, of which sclerocornea was the worst (p = 0.003). The main cause of graft failure was rejection (46.7%), followed by infection (26.7%) and primary endothelial decompensation (20%). When patients were sub-grouped according to age (under 12 months, between 12 to 48 months, and over 48 months), there was significant difference in graft survival time (p = 0.037) but not in overall graft survival rate (p = 0.154). Graft rejection occurred more frequently in patients between 12 to 48 months of age compared to other age groups (p = 0.016). Three out of 13 graft infections occurred in patients under 12 months of age. CONCLUSIONS: The type of disease causing corneal opacity was a significant factor affecting the clinical outcomes of penetrating keratoplasty in children.

Investigating the Relationship between Serum Interleukin-17 Levels and Systemic Immune-Mediated Disease in Patients with Dry Eye Syndrome

PURPOSE: To investigate the association between dry eye syndrome (DE) and serum levels of interleukin (IL)-17 in patients with systemic immune-mediated diseases. METHODS: IL-17 and IL-23 levels were measured in the sera of patients whose tear production was <5 mm on the Schirmer test. Subjects included patients with chronic graft-versus-host disease (GVHD), rheumatoid arthritis (RA), Sjogren's syndrome (SS), systemic lupus erythematosus (SLE), and no systemic disease. Corneal/conjunctival fluorescein staining was scored and the correlation between the score and the IL-17 level was evaluated. RESULTS: A strong correlation existed between IL-17 level and the type of systemic disease. IL-17 was significantly elevated in patients with chronic GVHD compared to those with RA and SS. IL-17 was not detectable in patients with SLE or in those without systemic disease. IL-23 was not detected in any of the subjects. IL-17 was significantly increased in patients with high fluorescein staining scores. CONCLUSIONS: Our data suggest that IL-17 is involved in the pathogenesis of DE in patients with systemic immune-mediated diseases.

Clinical Features, Predisposing Factors, and Treatment Outcomes of Scleritis in the Korean Population

PURPOSE: To evaluate the clinical features, associated factors, and treatment outcomes of scleritis in the Korean population. METHODS: Medical records were retrospectively reviewed for 94 eyes of 76 patients with scleritis. Clinical features of scleritis, including systemic disease, presence of microorganisms, serologic markers, history of previous ocular surgery, and use of immunosuppressants were investigated and compared amongst the subtypes of scleritis. Treatment outcomes were evaluated using best corrected visual acuity (BCVA) and time to scleritis remission. RESULTS: Nodular scleritis was the most common form observed, followed by necrotizing scleritis with inflammation, diffuse scleritis, and necrotizing scleritis without inflammation, respectively. A total of 16 of 76 patients (21.1%) had connective tissue diseases. Eleven cases (14.5%) had infectious scleritis, of which bacteria (54.5%) and fungi (45.5%) were the causative microorganisms. Thirty-three patients (43.4%) had previous ocular surgery, mostly pterygium excision. Notably, a history of pterygium excision was significantly associated with development of necrotizing and infectious scleritis (odds ratio [OR], 399 and 10.1; p < 0.001 and 0.002, respectively). In addition, patients with necrotizing scleritis were more likely to have infectious scleritis (OR, 11.7; p = 0.001). BCVA after treatment and time to remission also showed significant differences among the different scleritis subtypes. Systemic immunosuppression was required in addition to steroids for treating diffuse and necrotizing scleritis. CONCLUSIONS: Careful taking of patient history including previous pterygium excision should be performed, especially in patients with necrotizing and infectious scleritis. In addition, evaluation of microbiological infection can be crucial for patients with necrotizing scleritis and history of pterygium excision.

Clinical Manifestation and Predisposing Factors of Infectious Keratitis Following Penetrating Keratoplasty in Korean Patients

PURPOSE: To report the clinical manifestation, predisposing factors, microbiological profiles and treatment outcome of infectious keratitis following penetrating keratoplasty (PK). METHODS: Medical records of the post-PK patients later diagnosed with culture-positive keratitis, between January 2003 and June 2008 at our hospital were retrospectively reviewed. RESULTS: Among 228 eyes of 226 patients who previously had PK, 18 eyes (7.89%) of 16 patients developed microbial keratitis. Fifteen patients had a bacterial infection, of which a Streprococcus species was the most common causative microorganism (6 eyes, 33.3%). Three eyes had fungal infection; one case was co-infected with bacteria. Six eyes (33.3%) presented with a suture-related problem, and sixteen eyes (88.9%) had been using topical glaucoma medications. The suture-related problem and use of glaucoma medication were significantly associated with the development of infectious keratitis (p=0.040 and 0.013, respectively). Remission was achieved in all cases within the mean duration of 2.47 months after treatment initiation. However, visual improvement was not achieved in 11 eyes (68.7%) due to graft opacity. CONCLUSIONS: Early identification of predisposing factors and appropriate management at an early stage may prevent the occurrence of graft infection and improve graft survival.

Evaluation of Corneal Biomechanical Properties Following Penetrating Keratoplasty Using the Ocular Response Analyzer

PURPOSE: To evaluate corneal biomechanical properties in eyes that had previously undergone penetrating keratoplasty (PK) using the ocular response analyzer (ORA). METHODS: We recruited 26 patients who had received unilateral PK. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and cornea-compensated intraocular pressure (IOPcc) were measured with the ORA and were compared to the measurements from the contralateral eyes that did not undergo PK. RESULTS: The CH was 8.95+/-2.59 mmHg in eyes that underwent PK and 9.78+/-1.45 mmHg in the contralateral eyes that did not undergo PK (p=0.077). The CRF was 10.26+/-2.64 mmHg in post-PK eyes and 9.75+/-1.45 mmHg in the contralateral eyes (p=0.509), and the CH-CRF was significantly smaller in post-PK eyes (-1.31+/-2.32 mmHg in post-PK eyes vs. 0.03+/-0.88 mmHg in fellow eyes, p=0.016). The IOPg and IOPcc were significantly higher in the PK group than they were in the control group. The IOPcc's were 20.81+/-7.81 mmHg and 16.27+/-2.49 mmHg in post-PK and control eyes, respectively (p=0.011); and the IOPg's were 19.22+/-7.34 mmHg and 15.07+/-3.03 mmHg in post-PK and control eyes, respectively (p=0.019). The IOPcc-g's were 1.59+/-2.81 mmHg and 1.21+/-1.30 mmHg in post-PK and control eyes, respectively (p=0.412), and the central corneal thickness (CCT)'s were 489.11+/-90.60 microm and 556.24+/-42.84 microm in post-PK and control eyes, respectively (p=0.068). CONCLUSIONS: Following PK, CH tended to decrease while CRF tended to increase, significantly decreasing CH-CRF. A significantly higher intraocular pressure and a thinner CCT following PK may have contributed to the observed changes in these corneal biomechanical parameters.

Aspergillus fumigatus Scleritis Associated with Monoclonal Gammopathy of Undetermined Significance

A 68-year-old woman presented with pain in her left eye. Necrosis with calcium plaques was observed on the medial part of the sclera. Aspergillus fumigatus was isolated from the culture of the necrotic area. On systemic work-up including serum and urine electrophoresis studies, the serum monoclonal protein of immunoglobulin G was detected. The patient was diagnosed with monoclonal gammopathy of undetermined significance and fungal scleritis. Despite intensive treatment with topical and oral antifungal agents, scleral inflammation and ulceration progressed, and scleral perforation and endophthalmitis developed. Debridement, antifungal irrigation, and tectonic scleral grafting were performed. The patient underwent a combined pars plana vitrectomy with an intravitreal injection of an antifungal agent. However, scleral and intraocular inflammation progressed, and the eye was enucleated. Aspergillus fumigatus was isolated from the cultures of the eviscerated materials. Giemsa staining of the excised sclera showed numerous fungal hyphae.

Corneal Power Estimation Using Orbscan II Videokeratography in Eyes With Previous Corneal Refractive Surgeries

PURPOSE: To report three cases of corneal power estimation for intraocular lens power calculation using Orbscan II videokeratography in eyes with previous corneal refractive surgeries. CASE SUMMARY: In three eyes of three patients with previous corneal refractive surgeries, corneal power values were respectively measured at three, four, five, six mm-diameter zones of total mean, axial, tangential, and optical maps using Orbscan II videokeratography. Then, intraocular lens power values were calculated via the SRK/T formula. After cataract surgeries, back-calculated corneal power (BCK) values were estimated from post-phacoemulsification refraction data, and compared with those measured at three, four, five, six mm-diameter zones of each map in Orbscan II videokeratography. The postoperative refractive values after cataract surgeries were achieved within 1.5D of the target refraction in all eyes by using five mm total axial power and four mm total optical power for intraocular lens power calculation. Orbscan II parameters including three mm, four mm total axial power, and three mm total optical power were the least different from the BCK (0.69+/-0.49D, 1.08+/-0.54D, and 1.10+/-0.44D, respectively). CONCLUSIONS: If historical data are not available, Orbscan II videokeratography can be useful for estimating corneal power for intraocular lens power calculations in patients with previous corneal refractive surgeries.

Preliminary Effects of Oral Uridine on the Ocular Surface in Dry Eye Patients

We designed a randomized, double blinded, 3-months controlled prospective clinical study to investigate effects of oral uridine on the ocular surface in dry eye patients. Twenty-seven patients who diagnosed as dry eye with lower than 5 mm of wetting in the Schirmer strip, with corneal epithelial erosion and who completely followed-up till 3 months were enrolled. Corneal-conjunctival fluorescein staining, non-anesthetic Schirmer test, impression cytology, and Ocular Surface Disease Index (OSDI) were evaluated in the experimental and placebo groups at the baseline, 1 and 3 months after start of medication in a double blinded manner. Fluorescein stain score of the cornea was markedly decreased in oral uridine group compared to the placebo group at 3 months after medication (P=0.032, Mann-Whitney U test). The Schirmer wetting score for the oral uridine group was significantly increased (P=0.001, Wilcoxon signed rank test) at 3 months and its difference between two groups was statistically significant (P=0.030, Mann-Whitney U test). OSDI scores were significantly decreased at 1 and 3 months in treatment group. Oral uridine is effective in treatment of dry eyes.

DNA Microarray-Based Gene Expression Profiling in Porcine Keratocytes and Corneal Endothelial Cells and Comparative Analysis Associated with Xeno-related Rejection

Porcine to rat corneal xenotransplantation resulted in severe inflammation and rejection of the corneal stroma, whereas an allograft showed mainly endothelial cell-associated rejection. We, therefore, investigated and compared the gene expression between porcine keratocytes and corneal endothelial cells. RNA was isolated from primary cultured porcine or human keratocytes and porcine corneal endothelial cells. Gene expression was comparatively analyzed after normalization with microarray method using Platinum pig 13 K oligo chip (GenoCheck Co., Ltd., Ansan, Korea). Real-time polymerase chain reaction (PCR) was performed for C1R, CCL2, CXCL6, and HLA-A in porcine keratocytes and corneal endothelial cells. As a result, upregulated expression more than 2 folds was observed in 1,162 genes of porcine keratocytes versus porcine endothelial cells. Among the immune-regulatory genes, SEMA3C, CCL2, CXCL6, F3, HLA-A, CD97, IFI30, C1R, and G1P3 were highly expressed in porcine keratocytes, compared to porcine corneal endothelial cells or human keratocytes. When measured by real-time PCR, the expression of C1R, CCL2, and HLA-A was higher in porcine keratocytes compared to that in porcine corneal endothelial cells. In conclusion, the increased expression of C1R, CCL2, and HLA-A genes in porcine keratocytes might be responsible for the stromal rejection observed in a porcine to rat corneal xenotransplantation.

Efficient Cultivation Conditions for Human Limbal Epithelial Cells

To compare the stem niche in different culture conditions of limbal epithelial cells, the suspended human limbal epithelial cells (HLECs) were seeded on the 3T3-pretreated plates and the other suspended cells were plated on amniotic membranes (AMs) which were either cryo-preserved or freeze-dried. All were cultured for 10 to 12 days. Reverse transcription-polymerase chain reaction (RT-PCR) for ATP-binding casette, subfamily G, member 2 (ABCG2), p63, cytokeratin 12, and connexin 43 were performed in cultivated HLECs and their expression levels were compared. The mRNA expression of all markers examined showed no statistically significant differences between the cells on cryo-preserved and on freeze-dried AM. The expression of p63 and cytokeratin 12 in cultivated cells on AMs were significantly lower than those in 3T3-cocultured cells on RT-PCR and immunofluorescent staining. Cultivated HLECs on AMs showed reduced proliferation and differentiation while maintaining stem-property regardless of the preservative method of AM.

Short-term Efficacy of Topical Immunosuppressive Agents on the Survival of Cultivated Allo-Conjunctival Equivalents

PURPOSE: To investigate the short-term efficacy of topical immunosuppressive agents on the survival of cultivated allo-conjunctival equivalents. METHODS: Twenty-five eyes of New Zealand white rabbits were included. Temporal conjunctivae were trephined to a diameter of 7.5 mm, and then cultured allo-conjunctival epithelial cells on amniotic membrane were transplanted onto them. Various immunosuppressants including steroid, cyclosporine, and rapamycin were applied topically four times a day for a week. Epithelial defects and graft edema were graded daily. Numbers of inflammatory cells were measured in H&E. PKH26 and cytokeratin 4 and 7 were immunostained. RESULTS: Earlier epithelialization was observed in 1% steroid-treated eyes and defects persisted significantly in 0.5% CsA applied eyes. In histology, PKH26 positive cells considered as donor cells were only found in 1% steroid or 0.01% rapamycin applied eyes. 1% steroid- or 0.01% rapamycin-applied eyes both showed positive staining for keratin-4 and -7. Inflammatory cells were less found in 1% steroid or 0.01% rapamycin treated eyes. CONCLUSIONS: Topical steroid or rapamycin can help to suppress acute inflammation and enhance the acute survival of transplanted conjunctival cells.

The Role of Cyclosporine and Mycophenolate in an Orthotopic Porcine-to-Rat Corneal Xenotransplantation

We performed this study to investigate the feature of rejection in porcine-to-rat corneal orthotopic transplantation and to evaluate the effect of cyclosporine and mycophenolate on the xeno-rejection. Orthotopic corneal transplantation was done at 91 Sprague-Dawley rats, and they were divided into 10 groups based on the combination of immunosuppressants including dexamethasone, cyclosporine, and mycophenolate mofetil. Graft survival was analyzed and grafted eyes were examined with Hematoxylin & Eosin and CD4 or CD8 staining. Enzyme-linked immunosorbent assays were done for interleukin-2 (IL-2), IL-4, IL-5, IL-10, and interferon (IFN)-gamma in cornea, lacrimal gland, and cervical lymph nodes. The longest median survival of the immune suppressant group was 11.00+/-1.96 days, which showed no statistical differences compared with that of control (8.00+/-1.52 days). The neutrophils were prominent in the early phase but soon gave way to the monocytes. The number of CD8+ cells was higher than that of CD4+ cells. IL-2 and IFN-gamma markedly increased at 10 to13 days in cornea, lacrimal glands, and cervical lymph nodes, which showed a decrease with immunosuppressants except in the cornea. In conclusion, cyclosporine and mycophenolate could not prevent the rejection in porcine to rat orthotopic corneal xenograft associated with infiltraton of CD8+ and innate immune cells.

Optical Coherence Tomographic Finding in a Case of Macular Coloboma

PURPOSE: To report the optical coherence tomography (OCT) findings in a patient with unilateral macular coloboma. METHODS: A 12-year-old male was presented with macular coloboma in the left eye. The optical coherence tomography was performed with fluorescein angiography (FA). RESULTS: The OCT revealed the crater-like depression in the macula, demonstrating atrophic neurosensory retina, and an absence of retinal pigment epithelium and choroid in the lesion. FA showed hypofluorescence corresponding to the size of the lesion in both early and late frames without leakage of dye at any stage. CONCLUSIONS: The OCT can be beneficial to confirm the diagnosis of macular coloboma.

Early versus Late Intravitreal Triamcinolone Acetonide for Macular Edema associated with Branch Retinal Vein Occlusion

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of 3 months, were treated using a single intravitreal triamcinolone injection (4 mg/0.1 ml). Best-corrected visual acuity and foveal thickness by optical coherence tomography were measured 1, 3, and 6 months post-injection. RESULTS: In patients that received treatment after a disease duration of 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.

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.