Using 17-gauge Spinal Anesthesia Needle as an Insertion Guide for Frontalis Sling Surgery with Silicone Rod

PURPOSE: In this study we investigated the surgical outcome and effectiveness of using a 17-gauge spinal anesthesia needle for guiding insertion of the silicone rod in frontalis sling surgery for patients having severe myogenic or neurogenic ptosis with risk of exposure keratopathy. METHODS: This study included on 8 patients (11 eyes) who previously received frontalis sling surgery with a 17-gauge spinal anesthesia needle because of severe myogenic or neurogenic ptosis with risk of exposure keratopathy. We investigated the technique, surgical outcome, and clinical features following frontalis sling surgery, and evaluated the advantages of using a 17-gauge spinal anesthesia needle. RESULTS: The mean age of patients was 54 years. Third nerve palsy was the most common etiology in severe ptosis with risk of exposure keratopathy (5 of 8, 62.5%). Main advantages of the 17-gauge spinal anesthesia needle are smaller skin incision that allows for minimal damage during tissue passage and easy guide for insertion. Other advantages included sterilization, minimizing infections, sharpness without distortion because it is disposable, and economic value. The mean follow-up period was 21.4 months, and the upper lid margin of all patients was adequately high above the pupil margin. Additionally, no major complications were observed in the patients. CONCLUSIONS: Frontalis sling surgery with a silicone rod is a safe and effective method for patients with severe myogenic or neurogenic ptosis with risk of exposure keratopathy. The 17-gauge spinal anesthesia needle is useful and economical in frontalis sling surgery for guiding insertion of the silicon rod as an alternative option to the Wright needle.

20G silicone rod as monocanalicular stent in repair of canalicular lacerations: Experience from a tertiary eye care centre.

To evaluate the outcome of 20G silicone rod as monocanalicular stent in canalicular lacerations. Retrospective case series involving patients between July 2006 and June 2010. Fourteen canalicular repairs in 12 consecutive patients were done in the study period. Eleven were male and mean age was 30.5 years. A single canaliculus was involved in 10 patients and associated injury to the globe was noted in 3 patients. The median lag time between injury and repair was 3 (range 1-9) days. The mean duration of stenting was 6.9 (SD 3.2) weeks. Spontaneous extrusion of monocanalicular stent occurred in 3 patients. Patency on syringing was noted in 10 (70%) canaliculi over a median follow up of 7 (range 2-17) months. 20G silicone rod may be used as an effective and economical alternative in canalicular lacration repairs.

Frontalis Suspension Using a Silicone Rod in Blepharoptosis Patients with Poor Ocular Motility

PURPOSE: To determine the efficacy of frontalis sling operation with silicone rods in patients with compromised corneal protective mechanisms. METHODS: The authors retrospectively studied 6 consecutive patients (7 eyelids) with severe blepharoptosis with poor ocular motility who had undergone frontalis sling operations using silicone rods. RESULTS: Preoperative diagnoses included third nerve palsy in 4 patients, double elevator palsy in 1 patient, and suspicious oculopharyngeal muscular dystrophy in 1 patient. With a mean follow up of 27.7 months, a good final lid height was achieved in all 7 eyelids. Mild exposure keratopathy occurred postoperatively in 3 patients. During the follow-up period, no other significant complications, such as extrusion of the sling or infection, occurred. CONCLUSIONS: Silicone rods are effective and safe materials for use in frontalis suspension in treating blepharoptosis in patients with inadequate or absent Bell's phenomenon, resulting in poor eye protective mechanisms associated with an increased incidence of corneal exposure.

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 Silicone Rod

PURPOSE: To evaluate the surgical results and complications in patients with blepharoptosis who underwent frontalis suspension using a silicone rod. METHODS: A total of 31 lids of 23 patients with blepharoptosis and poor levator function underwent a pentagon-shaped loop silicone sling surgery in which six skin incisions were made. Eighteen patients had congenital ptosis, two blepharophimosis-ptosis syndrome, two blepharoptosis with superior rectus muscle weakness, and one third nerve palsy. RESULTS: With a mean age of 14 years and a mean follow-up of 16 months, good-to-excellent lid height was achieved in 27 lids (87%) of 20 patients and poor results with undercorrection in 4 lids (13%) of 3 patients. Three of the 4 lids with poor results had reoperation and satisfactory results were achieved. Transient exposure keratitis occurred postoperatively in 7 lids (23%) and persistent exposure keratitis in 2 lids (6%). During the follow-up period, extrusion of the sling and infection did not occur; ptosis recurred in 4 lids (13%). CONCLUSIONS: Silicone rod can be adjusted easily after frontalis suspension, but it needs to pay close attention because the string can be broken during the operation or follow-up period. It is considered that additional follow-ups for a long-term recurrence rate of ptosis are necessary and sufficient explanation to the patients and family and their understanding are need.