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Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy
S R Carter1, W J Meecham, S R Seiff
1Department of Ophthalmology, University of California San Francisco, CA 94143-0730, USA.
Insights
Silicone rod frontalis suspension effectively treats severe ptosis with poor levator function, achieving good lid height in most patients. This method is particularly beneficial for children with congenital ptosis and those with limited Bell
Area of Science:
- Ophthalmology
- Surgical Techniques
- Ptosis Repair
Background:
- Ptosis, or drooping eyelid, can impair vision and affect appearance.
- Severe ptosis often involves poor levator muscle function, necessitating alternative surgical approaches.
- Frontalis suspension using adjustable materials offers a potential solution for complex cases.
Purpose of the Study:
- To evaluate the efficacy of silicone rod frontalis sling surgery for ptosis repair.
- To assess outcomes in a diverse patient population with various causes of ptosis.
Main Methods:
- Retrospective study of 35 patients undergoing silicone rod frontalis sling repair.
- Analysis of 61 eyelids with a mean follow-up of 22 months.
- Inclusion of patients with congenital ptosis, chronic progressive external ophthalmoplegia, third-nerve palsy, myasthenia gravis, and glaucoma-related restriction.
Main Results:
- Excellent lid height achieved in all 61 treated eyelids.
- Ptosis recurrence occurred in 7% of lids, requiring revision.
- Postoperative exposure keratopathy occurred in 15% of eyes, primarily in those with inadequate Bell's phenomenon.
- Sling extrusion occurred in 5% of cases, mainly in younger patients.
Conclusions:
- Silicone rod frontalis suspension is an effective treatment for severe ptosis with poor levator function.
- The technique yields good visual outcomes in children with congenital ptosis and risk of amblyopia.
- Silicone's adjustable nature makes it suitable for ptosis associated with absent or minimal Bell's phenomenon.
Purpose:
To determine the efficacy of silicone rod frontalis sling ptosis repair in selected patients.
Methods:
The authors retrospectively studied 35 consecutive patients who underwent silicone sling ptosis repairs in 6 lids at the University of California, San Francisco.
Results:
Preoperative diagnoses included congenital ptosis causing developmental delay or possible amblyopia in children younger than 3 years of age, chronic progressive external ophthalmoplegia, third-nerve palsy, myasthenia gravis, and ocular restriction secondary to glaucoma filtering valves. With a mean follow-up of 22 months, good-to excellent final lid height was achieved in all 61 lids. Recurrence of the ptosis occurred in four lids (7%), requiring replacement of the silicone rod in two lids and revision of the original sling in two lids to reach the final lid height. Chronic exposure keratopathy without corneal infection occurred postoperatively in 9 (15%) of 61 eyes, all in patients with an inadequate or absent Bell phenomenon. Chronic corneal problems did not develop in any of the children. Extrusion of the sling with or without infection occurred in three foreheads (5%) in two patients younger than 15 years of age.
Conclusion:
Silicone rod is an effective material for use in frontalis suspension in treating severe ptosis with poor levator function. Children younger than 3 years of age with congenital ptosis and developmental delay or possible amblyopia can undergo silicone frontalis suspension to achieve good visual results. The elasticity and ease of adjustment of the silicone rod are ideal characteristics for a suspensory material used to correct severe ptosis associated with a minimal or absent Bell phenomenon, such as in chronic progressive external ophthalmoplegia, myasthenia gravis, or third-nerve palsy.