Long-term results of frontalis suspension using irradiated, banked fascia lata

This study was undertaken to study the long-term rate of recurrence of ptosis and other postoperative complications after frontalis suspension using banked irradiated fascia lata. One hundred thirty-two lids of 72 patients underwent frontalis suspension between 1980 and 1989. The preoperative diagnoses included severe congenital ptosis (83%), blepharophimosis (10%), third nerve palsy (4%), and chronic progressive external ophthalmoplegia (3%). The age at the time of surgery ranged from 5 months to 19 years, with an average of 3 years and 5 months. In 46 patients (64%), surgery was done before age 3 years. The follow-up time ranged from 6 to 15 years, with a mean and median of 10 years. Good to excellent lid height was achieved immediately after surgery in all but three patients. Recurrence of ptosis occurred in 20 cases (28%), and 28 lids (21%). The time to reoperation ranged from 1 to 7 years, with an average of 3 years. Sixteen patients (80%) with recurrence were younger than 3 years of age. Reaction to donor fascia lata occurred in only two patients (3%). Only one patient suffered from excessive exposure keratopathy and required revision of the sling. Banked fascia lata is easy to use and should be considered as an alternative suspensory material in children younger than 3 years of age with congenital ptosis. The long-term reoperation rate in this cohort of patients was higher than the 5% rate reported for autogenous fascia, but lower than that previously reported for banked fascia lata (50% at 8 years).