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Scanning electron microscopic studies of Supramid Extra from the patients displaying recurrent ptosis after frontalis
Koung Hoon Kook1, Helen Lew, Jee Ho Chang
1Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
Purpose:
To investigate the morphologic changes in Supramid Extra suture harvested from patients displaying recurrent ptosis who had undergone a frontalis suspension for congenital ptosis.
Design:
Observational case series.
Methods:
Using scanning electron microscopy, we examined the morphologic changes in Supramid Extra (S. Jackson Inc, Alexandria, Virginia, USA) harvested from 20 consecutive patients (23 eyelids) with recurrent ptosis who had undergone frontalis suspension. Disintegration was graded as mild, moderate, or severe.
Results:
Examination of unused Supramid showed the smooth surface of the sheath and round, well-demarcated polyfilaments on cross section. However, implanted Supramid showed different degrees of disintegration. The surface of the sheath had a rough texture with cracks and peeling. On cross section, an accumulation of debris among the polyfilaments and irregular architectures with decreased diameters of the polyfilaments were noted in some cases. On the surface of polyfilaments, different degrees of debris were noted in all cases. The degree of the changes was not exactly correlated with either the time of the recurrence or the duration of implantation. However, as the duration of implanted Supramid increased, greater changes on the surface of the sheath were noted. With implantation of less than 37 months, mild changes (44%) were predominant; between 37 and 48 months, moderate changes (60%) were noted, and with more than 48 months of implantation, severe changes (44%) were predominant.
Conclusions:
Supramid undergoes morphologic degradation by hydrolysis after implantation. This change might be considered one of the possible factors that facilitate the recurrence of ptosis.
Insights
Supramid Extra suture degrades over time after frontalis suspension surgery for congenital ptosis. This morphologic degradation may contribute to recurrent ptosis in patients.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Surgical Materials
Background:
- Frontalis suspension is a surgical technique used to correct congenital ptosis.
- Supramid Extra is a commonly used suture material for this procedure.
- Recurrence of ptosis after frontalis suspension can occur, necessitating further investigation into potential causes.
Purpose of the Study:
- To investigate the morphologic changes in Supramid Extra suture after implantation in patients with recurrent ptosis.
- To assess the relationship between suture degradation and the duration of implantation.
Main Methods:
- An observational case series design was employed.
- Scanning electron microscopy was used to examine Supramid Extra sutures harvested from 20 patients (23 eyelids) who experienced recurrent ptosis.
- Suture disintegration was graded as mild, moderate, or severe.
Main Results:
- Implanted Supramid Extra sutures exhibited varying degrees of disintegration compared to unused sutures.
- Morphologic changes included a rough sheath surface with cracks, debris accumulation among polyfilaments, and decreased polyfilament diameters.
- Suture degradation correlated with increased duration of implantation, with severe changes predominant after 48 months.
Conclusions:
- Supramid Extra sutures undergo morphologic degradation, likely due to hydrolysis, after implantation.
- This degradation process is a potential contributing factor to the recurrence of ptosis following frontalis suspension surgery.
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