silicon and Blepharoptosis

The routine technique of tarso-frontalis suspension surgery for simple congenital blepharoptosis with poor levator action is cosmetically less rewarding due to either an absence or asymmetry of the postoperative eyelid crease. The objective of this study was to assess the eyelid crease quality after a modified open method of tarso-frontalis suspension surgery compared to the closed method.. This was a retrospective comparative study reviewing the case sheets of all the patients undergoing unilateral tarso-frontalis suspension surgery with silicon rod employing Fox pentagon design from September 2017 to February 2019 at Mechi Eye Hospital, Jhapa, Nepal. A review of 40 case sheets of congenital lid ptosis with poor levator function(<4mm) aged 9 years or more was done. Tarso-frontalis suspension surgery, modified with a mini blepharoplasty incision, direct attachment of silicon rod to tarsus, completion of pentagon design with supra-brow incisions, and skin-orbicularis-tarsus-orbicularis-skin suture (open method) was done in 20 cases whereas other 20 cases underwent surgery with supraciliary stab incisions (closed method).. The mean age of the patients was 21.1+5.9 years (range 9-30 years). The ptosis amount ranged from 3-10mm. At the 6th postoperative month, most of the cases had good ptosis correction (90% open group, 85% closed group, p=0.74). However, cosmetic outcomes were better in the open group compared to the closed group: 100% symmetrical eyelid crease compared to 40% (p<0.001) and 90% acceptance rate for eyelid contour compared to 70% (p=0.23).. Predictable, targeted, and symmetrical lid crease can be obtained using the modified open method of tarso-frontalis suspension surgery.

Topics: Adolescent; Adult; Blepharoplasty; Blepharoptosis; Child; Humans; Oculomotor Muscles; Retrospective Studies; Silicon; Treatment Outcome; Young Adult

To compare the surgical outcomes of tarsofrontalis sling surgery using silicon rod versus supramaximal levator resection in patients of unilateral congenital ptosis with poor levator function (≤ 4 mm).. This randomized control study was conducted over a period of 18 months. 44 patients were enrolled in the study group. The study population was randomly divided into two groups (22 in each group). In Group A, congenital ptosis was treated with tarsofrontalis sling surgery using silicon rod and supramaximal levator resection was done in the group B. Follow-up examination was done at postoperative day 1, one week, 1 month, 6 months and 12 months. Surgical outcome measures were change in marginal reflex distance-1 (MRD 1), vertical palpebral fissure height (VPFH) and inter-eyelid difference of margin reflex distance 1 and complications in two groups.. The mean age of patients in group A was 7.25 ± 6.10 years ranging from 1-18 years and mean age of patients in group B was 5.64 ± 2.44 years ranging from 3 to 11 years. Good surgical outcome was obtained in 73-77% of both groups. MRD1and VPFH increased significantly after surgery from baseline in both the groups (p value < 0.001). Inter-eyelid MRD 1 difference also improved significantly in both groups following ptosis surgery.. Both supramaximal levator resection and tarsofrontalis sling surgery are equally effective in cases of unilateral ptosis patients with poor levator function and should be part of the surgical armamentarium for treating congenital ptosis.

Topics: Adolescent; Blepharoplasty; Blepharoptosis; Child; Child, Preschool; Humans; Infant; Oculomotor Muscles; Retrospective Studies; Silicon; Treatment Outcome

To compare the results of two different frontalis sling surgery techniques with silicon rod for ptosis: Fox's single pentagon technique and a modification of Crawford's double triangle technique.. In a randomized clinical trial, 52 eyes of 50 patients with severe ptosis and poor levator function (≤4 mm) were randomly assigned to the Fox group or the modified Crawford group. Cosmetic outcome, functional success, and lagophthalmos were compared.. The patients achieved a fair to good cosmetic outcome by subjective grading and a fair outcome by objective grading in both groups. The intergroup difference was not statistically significant (P > 0.05). However, patients with preoperative lateral droop had better cosmetic outcome in the modified Crawford group. Mean increase in marginal reflex distance 1 (MRD-1) was 4.0 ± 1.7 mm in the Fox group and 3.7 ± 1.1 mm in the modified Crawford group. Change in MRD-1 within groups was significant (P < 0.0001); however, the difference in the groups was not (P = 0.44). The mean lagophthalmos in the Fox group was 1.3 ± 0.7 mm versus 0.6 ± 0.7 mm in the modified Crawford group at final follow-up. This intergroup difference in lagophthalmos was statistically significant (P = 0.001).. Both techniques were effective in reducing the amount of blepharoptosis and achieving a natural appearing cosmetic outcome. In cases with predominant lateral droop, the modified Crawford's technique seems to produce better results, although the small number of cases does not permit statistical comparison.

Topics: Adolescent; Blepharoplasty; Blepharoptosis; Eyelids; Female; Humans; Male; Oculomotor Muscles; Postoperative Complications; Prosthesis Implantation; Retrospective Studies; Silicon; Suture Techniques