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Double Rhomboid Suture Technique for Congenital Ptosis
Insights
The double rhomboid frontalis sling is an effective, low-cost surgical technique for congenital ptosis in children. Early surgery before age 3 increases the likelihood of needing revision surgery.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital ptosis presents challenges for pediatric ophthalmologists regarding surgical timing and technique.
- Numerous surgical options exist, each with unique considerations.
Purpose of the Study:
- To evaluate the efficacy of the double rhomboid frontalis sling using nylon suture for congenital ptosis.
- To analyze revision rates and factors influencing surgical outcomes in pediatric patients.
Main Methods:
- Retrospective chart review of 69 pediatric patients.
- Analysis of 38 primary surgeries for congenital ptosis using a double rhomboid frontalis sling with nylon suture.
- Follow-up duration averaged over 51 months.
Main Results:
- A 23.9% revision rate was observed.
- Surgery before age 3 significantly increased the likelihood of requiring a second surgery (P = .007).
- Older pediatric patients were less likely to need revision surgery (P < .05).
Conclusions:
- The double rhomboid frontalis sling with nylon suture is an effective, cost-efficient technique for congenital ptosis.
- This technique is straightforward to learn and less expensive than autograft or allograft methods.
- Families should be informed about the increased risk of revision surgery if operating on younger children.
Purpose:
Congenital ptosis is a troubling eye condition for pediatric ophthalmologists. There are many considerations to contemplate when deciding when to operate and which technique to use.
Methods:
A retrospective chart review of 69 pediatric patients treated for congenital ptosis using a double rhomboid frontalis sling with a nylon suture at a single tertiary care center.
Results:
For patients with more than 6 months of follow-up, there were 38 patients with 46 primary surgeries (22 [58%] males and 16 [42%] females). The average age at the first surgery was 39.34 ± 33.18 months. There was a mean follow-up time of 51.87 ± 53.79 months. There were 7 children who needed one revision and 1 child who needed a second revision, equaling a 23.9% rate of revision. Patients who had surgery before the age of 3 years had a statistically significant likelihood of needing a second surgery (chi-square test = 7.246, P = .007, 95% confidence interval = 0.027 to 0.687). It was also statistically significant (P < .05) that, throughout childhood, older patients were less likely to need a revision.
Conclusions:
A double rhomboid frontalis sling using a nylon suture is an effective technique to treat congenital ptosis. This technique is easy to master and has a low cost compared to techniques involving autografts and allografts. It is also important to advise the family of the likelihood of a second surgery if there is a need to operate at a young age. [J Pediatr Ophthalmol Strabismus. 2018;55(2):117-121.].
