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Arici C, Buttanri İB. Comparison of Stab Incision and Eyelid Crease Incision Techniques in Children with Revision Frontalis Sling Surgeries Using Silicone Rods. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:17-22. [PMID: 38104597 PMCID: PMC10869423 DOI: 10.3341/kjo.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 09/18/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To compare stab and eyelid crease incision techniques in revision frontalis sling surgeries using silicone rods. METHODS This retrospective study involved 52 eyes in 48 consecutive pediatric patients who underwent revision frontalis sling surgery between 2008 and 2019. All primary surgeries were performed by making eyelid crease incisions and suturing of silicone rods onto the tarsal plates. The revision surgeries were performed by either making stab incisions over the eyelid through which to pass the silicone rods (group A), or by refixing the same or a new silicone rod to the tarsal plate (group B). The surgical results were compared. RESULTS The mean follow-up period was 22.4 months (range, 6-62 months) and the mean age of the patients was 6.1 years (range, 1-16 years). There were 28 female and 20 male patients. Surgical success was achieved in 23 of 28 patients (82.1%) in group A, and 12 of 24 patients (50.0%) in group B. The difference between the groups was statistically significant (p = 0.012). Superficial punctate epithelial defects were detected in six group A patients (21.4%) and seven group B patients (29.1%). In group B, lid hematoma occurred in three patients (12.5%) and entropion occurred in three patients (12.5%). The silicone rods were removed from two eyes, and entropion spontaneously resolved in one eye with close follow-up. CONCLUSIONS Using the stab incision technique increases revision frontalis sling surgery success rates when primary surgeries are performed using eyelid crease incisions and suturing silicone rods to the tarsal plates in children.
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Affiliation(s)
- Ceyhun Arici
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul,
Turkiye
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Safety and Efficacy of the Under-Corrected Frontalis Sling in Myogenic Ptosis Accompanying Extraocular Muscle Paralysis. J Craniofac Surg 2020; 31:e802-e805. [PMID: 33136917 DOI: 10.1097/scs.0000000000006759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The surgical treatment of myogenic ptosis accompanying extraocular muscle paralysis is an intractable problem in the field of oculoplastic surgery due to the severe complications such as exposure keratopathy. It is promising to find an appropriate procedure to treat this kind of patients, which is able to ensure the safety and efficacy. METHODS The authors retrospectively reviewed 12 eyes of 6 patients who underwent the under-corrected "double V-Loop" frontalis suspension sling procedure for myogenic ptosis accompanying extraocular muscle paralysis and access the safety and efficacy of this kind of surgery. All the patients underwent corneal fluorescein staining and confocal microscopy before and after the surgery to inspect the corneal condition. The density of central corneal epithelial cells and endothelial cells were observed. RESULTS After the surgery, the eyelids contour was natural, and the symmetry was achieved in these cases. The average palpebral fissures height changed from 2.75 ± 1.41 mm to 4.50 ± 0.35 mm (P = 0.0007) and margin reflex distance 1 changed from -1.25 ± 1.22 mm to +0.50 ± 0.35 mm (P = 0.0002). Out of 12 operated eyes, mild postoperative lagophthalmos was present in 4 cases but without exposure keratopathy during the follow-up, the confocal microscopy showed that there were no significant differences in central corneal superficial epithelial cells (P = 0.93) and endothelial cells (P = 0.90) before and after the surgery. CONCLUSION The under-corrected "double V-Loop" frontalis suspension sling is a proper surgery in myogenic ptosis accompanying extraocular muscle paralysis, which leads to a low occurrence of exposure keratopathy, maintains the integrity of the cornea, and remains the patients' vision function.
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Bee YS, Tsai PJ, Lin MC, Chu MY. Factors related to amblyopia in congenital ptosis after frontalis sling surgery. BMC Ophthalmol 2018; 18:302. [PMID: 30463547 PMCID: PMC6249929 DOI: 10.1186/s12886-018-0962-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/29/2018] [Indexed: 12/05/2022] Open
Abstract
Background Amblyopia is a main concern in children undergoing frontalis sling surgery for repairing congenital ptosis. This study aimed to evaluate factors related to amblyopia in children undergoing frontalis sling surgery. Methods IRB-approved retrospective review of children under the age of 12 who received frontalis sling surgery. Preoperative demographic data, strabismus, margin reflex distance 1 (MRD1), lid fissure height, sling type, refraction errors, surgical outcome and amblyopia were evaluated. Results This study included 48 eyelid procedures performed in 38 patients. Median age was 4.0 years. Etiology was congenital ptosis in 42 eyes (87.5%) and blepharophimosis in 6 eyes (12.5%). Mersilene mesh was the sling material used in 36 eyes (75%), silicone in 6 eyes (12.5%), and polytetrafluoroethylene (PTFE) in 6 eyes (12.5%). Mean duration of follow-up was 27.8 ± 25.0 months (range, 3 to 128 months). Amblyopia was observed in 17 eyes (35.4%) at the final follow-up. Factors significantly associated with final amblyopia included blepharophimosis (p = 0.017), preoperative MRD1 ≤ − 1.0 mm (p = 0.038), preoperative lid fissure ≤4.5 mm (p = 0.035), preoperative anisometropia (spherical equivalent) (p = 0.011), and postoperative astigmatism (p = 0.026). Conclusions Study results suggest that blepharophimosis, preoperative MRD1 ≤ − 1.0 mm, preoperative lid fissure ≤4.5 mm, preoperative anisometropia (spherical equivalent), and postoperative astigmatism are associated with amblyopia after frontalis sling surgery in patients with congenital ptosis.
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Affiliation(s)
- Youn-Shen Bee
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st RD, Kaohsiung, 81346, Taiwan. .,Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan. .,National Defense Medical Center, Taipei, Taiwan.
| | - Pei-Jhen Tsai
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st RD, Kaohsiung, 81346, Taiwan
| | - Muh-Chiou Lin
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st RD, Kaohsiung, 81346, Taiwan
| | - Ming-Ying Chu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st RD, Kaohsiung, 81346, Taiwan
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Revision Surgery for Undercorrected Blepharoptosis After Frontalis Sling Operation Using Autogenous Fascia Lata. Ophthalmic Plast Reconstr Surg 2018; 34:487-490. [PMID: 29923964 DOI: 10.1097/iop.0000000000001152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Undercorrected blepharoptosis can be encountered after frontalis sling operation. Revision surgery for undercorrection has commonly involved introducing a new sling material. We describe and evaluate a simple surgical technique to correct undercorrection by adjusting preexisting fascia. METHODS This is a retrospective interventional case series of patients undergoing sling revision between February 2010 and February 2017. Skin incision was made on the previous incision line. Careful dissection was performed superiorly to identify a preexisting fascia, and the dissected fascia was reattached to the tarsal plate using nonabsorbable sutures with adjustments for eyelid height and contour. The success of the procedure was defined as less than 1 mm of difference in the marginal reflex distance 1 of both eyes without any contour deformity. RESULTS Twenty-one eyelids in 18 patients were included with a mean follow-up of 17.5 months (range 6-48) and a mean age of 14.7 years (range 5-57). All patients had undergone frontalis sling with autogenous fascia lata for congenital ptosis. Undercorrection due to recurrent ptosis was found in 12 eyelids, and contour deformity such as temporal ptosis was found in 9 eyelids. The mean time interval between previous frontalis sling operation and sling revision was 6.8 years. Nineteen patients (90.5%) achieved surgical success and a cosmetically acceptable appearance. CONCLUSION Sling revision is a simple and effective method with low perioperative morbidity for cases of undercorrection or contour deformity following frontalis sling operation using autogenous fascia lata, even long after the primary procedure.
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van Sorge AJ, Devogelaere T, Sotodeh M, Wubbels R, Paridaens D. Exposure keratopathy following silicone frontalis suspension in adult neuro- and myogenic ptosis. Acta Ophthalmol 2012; 90:188-92. [PMID: 20222904 DOI: 10.1111/j.1755-3768.2010.01876.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the incidence of exposure keratopathy following silicone frontalis suspension in adult neuro- and myogenic blepharoptosis. METHOD Retrospective noncomparative analysis of the charts of 69 cases (101 eyelids) of silicone frontalis suspension. RESULTS Sixty-one patients (93 eyelids) had myogenic ptosis, and eight patients (eight eyelids) had neurogenic ptosis. Preoperative diagnoses included chronic progressive external ophthalmoplegia, myotonic dystrophy, oculopharyngeal dystrophy, third cranial nerve palsy because of trauma or other causes. Average age at the time of operation was 54. Mean interval between the intervention and the first and second postoperative control was 8 and 28 months, respectively. Thirty-one patients (31 eyelids) needed a second follow-up visit. Postoperative punctate epithelial erosions (PEE) were encountered most frequently in patients with Steinert's disease (42% of eyes) and congenital ptosis (33% of eyes). Patients with oculopharyngeal dystrophy did not develop PEE. Corneal ulceration developed in three eyes (two patients): one eye was successfully treated with local antibiotic ointments and lubricants, a bilateral corneal ulceration in the second patient was successfully treated with partial conjunctival grafts. CONCLUSION This study cohort demonstrated a 26% risk of exposure keratopathy following silicone frontalis suspension. The risk of major corneal complications, such as ulceration, was low (3%).
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Affiliation(s)
- Arlette J van Sorge
- The Rotterdam Eye Hospital, Department of Oculoplastic and Orbital Surgery, 3000 LM Rotterdam, The Netherlands
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Kim AR, Choi CW, Kim SD. Effect of the Simultaneous Operation of Levator Resection and Frontalis Suspension for Congenital Ptosis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.12.1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ah Ron Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Chang Wook Choi
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Sang Duck Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea
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Takahashi Y, Leibovitch I, Kakizaki H. Frontalis suspension surgery in upper eyelid blepharoptosis. Open Ophthalmol J 2010; 4:91-7. [PMID: 21331314 PMCID: PMC3040462 DOI: 10.2174/1874364101004010091] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 06/25/2010] [Accepted: 07/19/2010] [Indexed: 11/22/2022] Open
Abstract
Frontalis suspension is a commonly used surgery that is indicated in patients with blepharoptosis and poor levator muscle function. The surgery is based on connecting the tarsal plate to the eyebrow with various sling materials. Although fascia lata is most commonly used due to its long-lasting effect and low rate of complications, it has several limitations such as difficulty of harvesting, insufficient amounts in small children, and postoperative donor-site complications. Other sling materials have overcome these limitations, but on the other hand, have been reported to be associated with other complications. In this review we focus on the different techniques and materials which are used in frontalis suspension surgeries, as well as the advantage and disadvantage of these techniques.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
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Outcomes in silicone rod frontalis suspension surgery for high-risk noncongenital blepharoptosis. Ophthalmic Plast Reconstr Surg 2010; 25:361-5. [PMID: 19966648 DOI: 10.1097/iop.0b013e3181b3b183] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the outcomes of silicone rod frontalis suspension for complicated cases of ptosis with poor levator function. METHODS A retrospective interventional case series of consecutive patients undergoing silicone rod frontalis suspension by 2 surgeons over 20 years generated records of 51 eyelids (33 patients) with ptosis secondary to cranial nerve III palsy, myasthenia gravis, chronic progressive external ophthalmoplegia, or oculopharyngeal dystrophy. Outcome measures included postoperative change in eyelid height, lagophthalmos, and corneal fluorescein staining; need for reoperation; patient and physician satisfaction; grading of postoperative photographs; and interobserver agreement. RESULTS Forty-five percent of patients had preoperative corneal staining. Surgery resulted in a significant increase in eyelid height (+2.8 mm; p < 0.0001), lagophthalmos (+0.4 mm, p < 0.0001), and corneal staining grade (+0.3 units; p = 0.02). Most patients achieved a subjectively acceptable result. Patient and physician agreement with outcome assessment was good (kappa = 0.65, p < 0.0001). Twenty eyelids (39%) required revision of the silicone sling, most often for adjustment of eyelid height. Survival analysis differed by diagnosis (p = 0.0154) and was most favorable for patients with myasthenia gravis. Interobserver agreement on postoperative photographs was marginal. CONCLUSIONS Silicone rod frontalis suspension surgery increases the eyelid height in complicated blepharoptosis patients with minimal eyelid excursion. Patients and physicians concur closely regarding satisfaction; masked assessment of photographic outcome parameters by observers yields marginal agreement. Because most patients undergoing this procedure have a narrow window for appropriate postoperative eyelid height, a relatively high proportion of patients required revision. Silicone rod frontalis suspension surgery is chosen in these challenging cases for the ease of adjustment.
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Morris CL, Buckley EG, Enyedi LB, Stinnett S, Freedman SE. Safety and efficacy of silicone rod frontalis suspension surgery for childhood ptosis repair. J Pediatr Ophthalmol Strabismus 2008; 45:280-8; quiz 289-90. [PMID: 18825901 DOI: 10.3928/01913913-20080901-11] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of silicone rod frontalis suspension surgery for childhood ptosis. METHODS The authors retrospectively studied 89 consecutive children (110 eyelids) who had silicone rod frontalis suspension surgery for ptosis at Duke University Eye Center from 1983 to 2004. Marginal reflex distance1 (MRD1) elevation of 2 mm or more (vs preoperative MRD1) was considered satisfactory. MRD1 was measured as the vertical distance from the corneal light reflex in primary gaze to the upper eyelid margin. The postoperative eyelid symmetry (< or = 1 mm = satisfactory) was the difference between the MRD1 of the surgical and fellow eyelid. RESULTS Median age at surgery was 45 months (range: 3 to 223 months) and median follow-up was 17 months (range: 1 to 88 months). Ptosis types (number of eyelids) were unilateral congenital (53), bilateral congenital (30), third nerve palsy (16), Marcus Gunn jaw wink (7), trauma (2), and myasthenia gravis (2). Median MRD1 elevation was 2 mm or greater for all ptosis types, whereas satisfactory postoperative symmetry occurred in 60% of unilateral and 100% of bilateral congenital ptosis cases (last follow-up). Complications occurred in 10 eyelids (9%) and reoperation occurred in 10 eyelids (9%). CONCLUSION The use of silicone rod frontalis suspension surgery for ptosis repair in pediatric patients is modestly effective, with few complications and easy removal and adjustment.
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Choi YJ, Kim YD. Frontalis Suspension Using a Silicone Rod in Blepharoptosis Patients with Poor Ocular Motility. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.4.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young-Joo Choi
- Department of Ophthalmology, Ulsan University School of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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DeMartelaere SL, Blaydon SM, Cruz AAV, Amato MM, Shore JW. Broad fascia fixation enhances frontalis suspension. Ophthalmic Plast Reconstr Surg 2007; 23:279-84. [PMID: 17667097 DOI: 10.1097/iop.0b013e31806b16a9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the use of a modified frontalis suspension procedure for congenital ptosis patients with minimal to no levator function. METHODS Retrospective, non-comparative case series of frontalis suspension by 2 surgeons over a 21-year period. RESULTS Frontalis suspension with broad fascia fixation was performed on 48 eyelids of 25 patients. All patients had visual obscuration due to blepharoptosis with only 0 mm to 2 mm of measurable levator function. Age ranged from 3 to 13 years. Minimum length of follow-up was 6 months (range, 6-174 months). The palpebral fissure was increased in all patients, improving their head position and unmasking their visual axis in primary gaze. Postoperatively, all patients developed transient exposure symptoms. There were no migrations, extrusions, infections, or granulomas. All patients achieved a satisfactory postoperative result based on eyelid position, function, and contour. CONCLUSIONS This modified frontalis suspension procedure maximizes frontalis muscle recruitment, creating powerful eyelid elevation with stable effect over time. The technique minimizes other procedures' pitfalls and advances in cosmesis are achieved with enhanced eyelid crease formation and adjustable eyelid contour.
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Bernardini FP, de Conciliis C, Devoto MH. Frontalis suspension sling using a silicone rod in patients affected by myogenic blepharoptosis. Orbit 2002; 21:195-8. [PMID: 12187412 DOI: 10.1076/orbi.21.3.195.7171] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The charts of 10 patients affected by myogenic ptosis who underwent surgical correction by means of a frontalis suspension sling using a silicone rod were reviewed. The patients included in the study were affected by ptosis secondary to myasthenia gravis (MG), chronic progressive external ophthalmoplegia (CPEO) or mitochondrial myopathy (MM). In every patient the ptosis was severe (MRD( 1) < 2 mm), with the eyelid partially or totally occluding the visual axis; levator function was poor (<5 mm), Bell's phenomenon was poor or absent and the orbicularis function was reduced. Final eyelid height, patient satisfaction and the presence of complications were our main outcome measures. Analysis of the results showed that the ptosis was corrected in every patient with a clear visual axis. One patient with absent Bell's and poor levator function had exposure keratopathy resistant to medical treatment and required surgical revision. We believe that the frontalis suspension sling is safe, effective and is the procedure of choice for patients affected by poor-function acquired ptosis. A silicone rod, because of its elasticity, is the material of choice in this selected category of patients.
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Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology 1996; 103:623-30. [PMID: 8618762 DOI: 10.1016/s0161-6420(96)30643-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
- S R Carter
- Department of Ophthalmology, University of California San Francisco, CA 94143-0730, USA
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Leone CR, Shore JW, Van Gemert JV. Silicone Rod Frontalis Sling For the Correction of Blepharoptosis. Ophthalmic Surg Lasers Imaging Retina 1981. [DOI: 10.3928/1542-8877-19811201-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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