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Feng J, Wei S, Pang L. Mersilene tape versus conventional sutures in transvaginal cervical cerclage: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:819. [PMID: 38007447 PMCID: PMC10675920 DOI: 10.1186/s12884-023-06141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE This study aimed to assess the effectiveness of Mersilene tape versus alternative suture types in prolonging singleton pregnancies as well as other pregnancy and neonatal outcomes, in cases of history-, ultrasound-, and exam-indicated cervical cerclage. METHODS A systematic review was conducted to identify relevant studies comparing different suture types in cervical cerclage procedures. The primary outcome of interest was preterm birth (PTB) rate < 37, <35, < 28, and < 24 weeks. Statistical analyses were performed to determine the relationship between suture type and various outcomes. RESULTS A total of five studies, including three randomized controlled trials (RCTs) and two retrospective studies, with a combined participation of 2325 individuals, were included. The pooled analysis indicated no significant association between suture type and PTB at less than 37 weeks of gestation (RR: 1.02, 95% CI: 0.65-1.60, p < 0.01, I2 = 74%). Women who received Mersilene tape had a higher risk of PTB at 34-37 weeks (RR: 2.62, 95% CI: 1.57-4.37, p = 0.69, I2 = 0%), but a lower risk of PTB at less than 34 weeks (RR: 0.43, 95% CI: 0.28-0.66, p = 0.66, I2 = 46%). No statistically significant differences were observed for PTB before 28 weeks (RR: 1, 95% CI: 0.65-1.53, p = 0.70, I2 = 0%), before 24 weeks (RR: 0.86, 95% CI: 0.60-1.23, p = 0.33, I2 = 0%), incidence of chorioamnionitis (RR: 0.97, 95% CI: 020-4.83, p < 0.01, I2 = 95%), neonatal intensive care unit (NICU) admission (RR: 0.79, 95% CI: 0.28-2.22, p = 0.08, I2 = 67%) and neonatal death (RR: 1.00, 95% CI: 0.42-2.35, p = 0.17, I2 = 48%). CONCLUSION Our findings suggest that Mersilene tape does not reduce the risk of PTB before 37, 28 or 24 weeks. We observed higher risk of preterm birth between 34 and 37 weeks with Mersilene tape but lower incidence before 34 weeks, a period with higher neonatal morbidity and mortality. Due to the limited number of studies, our results and their clinical significance should be interpreted with caution.
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Affiliation(s)
- Juntao Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Shisi Wei
- Guangxi Medical University, Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Lihong Pang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road, Nanning, Guangxi, 530021, China.
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Chan NSW, Young S, Yuen HK, Henson RD. Survey of ptosis practice patterns among surgeons in Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS). Orbit 2023; 42:42-51. [PMID: 34989292 DOI: 10.1080/01676830.2021.2021540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To characterize the preferred ptosis practice patterns and variations among oculoplastic surgeons in the Asia-Pacific region. METHODS A web-based questionnaire was sent to both members and non-members registered under the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS)'s email database. The survey included preoperative testing practices, surgical preferences for adult aponeurotic and congenital ptosis, various surgical techniques (anterior and posterior approach ptosis procedures, and frontalis sling procedures) and postoperative practices. RESULTS A total of 386 survey invitations were sent. There was a response rate of 68.7% from respondents from 20 countries in the Asia-Pacific region. There was variation in the preoperative evaluation and management of ptosis. Anterior approach ptosis surgery (96.6%) and frontalis sling procedures (86.8%) were performed by more surgeons than posterior approach ptosis surgery (47.2%). There was a deviation from the traditional frontalis sling procedures for patients with poor levator function. CONCLUSIONS Our survey results provide insight into the variation in the assessment and management of ptosis amongst oculoplastic surgeons in the Asia-Pacific region. It also demonstrates some differences between practice patterns in Asia-Pacific and America.
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Affiliation(s)
| | - Stephanie Young
- Department of Ophthalmology, National University Hospital, Singapore.,Eagle Eye Centre, Singapore
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Landau Prat D, Ramakrishnan M, Zhao C, Revere K, Katowitz WR, Katowitz JA. Silicone sling frontalis suspension for congenital ptosis: Outcome of 174 consecutive cases. Clin Exp Ophthalmol 2022; 50:608-614. [PMID: 35610953 DOI: 10.1111/ceo.14112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/28/2022] [Accepted: 05/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Frontalis suspension (FS) is the treatment of choice in congenital ptosis with poor levator function. We report the surgical outcome of FS using a double triangle configuration of silicone slings in children. METHODS A retrospective cohort study of all paediatric patients with simple myogenic congenital ptosis repaired with FS over a 12-year period (2009-2020). Each silicone sling was secured by simple knots. Pre- and post-operative margin reflex distance (MRD1 ) measurements were determined from clinical photographs using ImageJ Software. Main outcome measures were improvement in eyelid height, eyelid asymmetry, reoperation rate and timing. RESULTS One hundred and thirty nine patients (174 eyes) were included, with 35 (25%) having bilateral surgery. Mean (±SD) age was 1.4 ± 1.9 years. Mean follow up time was 32 ± 20.5 months. Sixteen patients (11%) had a history of previous ptosis repair surgery. Mean MRD1 improved by an average of 1.5 mm. The final MRD1 in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD1 difference between both eyes in all unilateral cases improved from 2.5 mm preoperatively to 1.2 mm at final visit (p < 0.001). In the 123 cases without a history of previous ptosis surgery, repeat ptosis repair was performed in 37 (30%) patients, 34.9 ± 19.9 months after the initial procedure. Overall, repeat repair was performed in 47 patients (34%). CONCLUSIONS Double triangle silicone sling frontalis suspension has a favourable outcome in two-thirds of paediatric patients with simple myogenic congenital ptosis. Failed cases can be addressed with a second repair, using either autogenous fascia lata or a second silicone sling.
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Affiliation(s)
- Daphna Landau Prat
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA.,The Sheba Talpiot Medical Leadership Program, Division of Ophthalmology, The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meera Ramakrishnan
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - Cindy Zhao
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - Karen Revere
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - William R Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - James A Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
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DOGAN S. OURS RESULTS OF WHITNALL SLING IN PATIENT WITH CONGENITAL MYOGENIC PTOSİS. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.946730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Levator fonksiyonu kötü doğumsal üst gözkapağı düşüklüğünde whitnall askılama ameliyatı uyguladığımız hastaların klinik özelliklerini ve cerrahi sonuçlarını sunmak.
Yöntemler: XXX Hastanesi'nde 2003-2005 yıllarında whitnall askı cerrahisi uygulanan 11 hastanın 15 gözü çalışmaya alındı. Hastaların dördü kadın, yedisi erkek olup, yaşları 5 ile 40 yıl arasındaydı. Gözkapağı düşüklüğü dışında sistemik ve oküler patolojileri olanlar çalışmaya alınmadı. Tüm hastalarda anterior yaklaşımla kapak kıvrım insizyonu ile whitnall askı cerrahisi uygulandı. Üst gözkapağı konturunun düzenli olması, kapak çizgisinin simetrik olması şartıyla, tam düzeltme ve bir mm’den az kapak düşüklüğü olanlar ‘başarılı’, 1-2 mm kapak düşüklüğü olanlar ‘tatminkar’, iki mm den daha fazla kapak düşüklüğü olanlar ‘başarısız’ olarak değerlendirildi.
Bulgular: Ameliyat sonrası 6. ayda hiçbir hastada kapak kontür düzensizliği ve enfeksiyon gibi komplikasyonlar izlenmedi. Bir hastada iki mm'den fazla kapak düşüklüğü nedeni ile başarısız kabul edildi. Bir hasta ise 1-2 mm arasında kapak düşüklüğü olmasına rağmen optik aks açık olduğu için tatminkar olarak değerlendirildi. Dokuz hastanın 13 gözünde (%86.7) ise bir mm'nin altında kapak düşüklüğü vardı ve sonuç başarılı olarak değerlendirildi.
Sonuç: Kötü levator fonksiyonlu hastalarda whitnall askı cerrahisi başarı oranı yüksek ve komplikasyon oranı düşük bir tekniktir. Uzun dönem sonuçlar için karşılaştırmalı geniş serili prospektif çalışmalara ihtiyaç vardır.
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Affiliation(s)
- Semih DOGAN
- İSTANBUL GELİŞİM ÜNİVERSİTESİ, GELİŞİM MESLEK YÜKSEKOKULU, TIBBİ HİZMETLER VE TEKNİKLER BÖLÜMÜ
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Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair. J Craniofac Surg 2021; 32:2358-2361. [PMID: 34054081 DOI: 10.1097/scs.0000000000007761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Frontalis flap advancement is an alternative means of congenital ptosis repair from frontalis suspension utilizing autologous fascia or allogenic implants. Variations in technique, including flap division, location and number of skin incisions, and dissection planes, are described in the literature. MATERIALS AND METHODS A retrospective case series of patients with congenital myogenic ptosis treated with simplified, minimal dissection frontalis flap advancement involving a single upper eyelid crease incision with dissection in the preseptal and subcutaneous planes without division to mobilize the frontalis flap. Inclusion criteria: pediatric patients age < 18 years with either primary or recurrent congenital ptosis following previous surgical repair. Exclusion criteria: ptosis of neurogenic etiology or postoperative follow-up < 3 months. Primary outcome measures were postoperative margin-reflex distance 1 (MRD1), the difference in MRD1 between surgical and nonsurgical eyelids in unilateral ptosis, and lagophthalmos. Secondary outcome measures included recurrence and complications. RESULTS Twenty-six patients met inclusion criteria, 24 males and 2 females. Mean postoperative MRD1 at last follow-up was 2.9 ± 1.2 mm and the mean difference in MRD1 between surgical and nonsurgical eyelids at last follow-up was 1.1 ± 1.0 mm. Average lagophthalmos at postoperative month 2 to 5 was 0.6 ± 0.7 mm. One patient demonstrated postoperative lid retraction that required re-operation. Four of 31 eyelids (12.9%) demonstrated ptosis recurrence at 5, 12, or 24 months. CONCLUSIONS In this retrospective series, the authors report clinically and statistically significant surgical eyelid height improvement and symmetry between nonsurgical and surgical eyelids in congenital ptosis patients treated with minimal dissection direct frontalis flap advancement.
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Agarwal P, Sharma D, Agrawal V, Tiwari S, Kukrele R. Double Rectangle Fascia Lata Frontalis Sling: A Rationale Approach for Ptosis. Indian J Plast Surg 2021; 54:58-62. [PMID: 33814743 PMCID: PMC8012781 DOI: 10.1055/s-0041-1723909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background
The purpose of this study was to evaluate the functional outcomes of a modified technique of double rectangle pattern for correction of severe ptosis.
Methods
This is a retrospective study over a period of 8 years including patients who underwent correction of ptosis by double rectangle using autologous fascia lata sling. Surgical outcomes were assessed postoperatively by distance from the corneal light reflex to the upper eyelid margin (MRD1) and levator function.
Results
Twenty-six eyelids were operated in 20 patients. There were 9 males and 11 females, with age ranging from 4 to 35 years. Preoperatively, all patients had poor MRD1 and poor levator function. Postoperative MRD1 was good in 13 patients (17 eyelids), fair in 5 (7eyelids), and poor in 2 patients (2 eyelids). Postoperative levator function was excellent in 12 patients (15 eyelids), good in 6 (9 eyelids), and fair in 2 patients (2 eyelids). At a mean follow-up of 12 months, adequate correction was achieved in 24 eyelids, and 2 eyelids had undercorrection.
Conclusion
Frontalis sling with a double rectangle is simple and more efficient, as it provides a straight line of pull to the eyelid for correction of severe ptosis.
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Affiliation(s)
- Pawan Agarwal
- Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh, India
| | - Dhananjaya Sharma
- Department of Surgery NSCB Government Medical College, Jabalpur, Madhya Pradesh, India
| | - Vikesh Agrawal
- Paediatric Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh, India
| | - Swati Tiwari
- Department of Surgery NSCB Government Medical College, Jabalpur, Madhya Pradesh, India
| | - Rajeev Kukrele
- Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh, India
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Ben Abdesslem N, Knani L, Mili W, Mahjoub A, Ben Rayana N, Ghorbel M, Mahjoub H. [Management of blepharophimosis, ptosis, epicanthus inversus syndrome at a referral center in Tunisia]. J Fr Ophtalmol 2020; 44:53-62. [PMID: 33279286 DOI: 10.1016/j.jfo.2020.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Blepharophimosis ptosis epicanthus inversus syndrome (BPES) is a rare congenital hereditary abnormality. It includes complex orbital-palpebral malformations, causing aesthetic and functional ramifications. Management of BPES requires two steps : diagnosis and treatment. PATIENTS AND METHODS We performed a retrospective descriptive study of 44 patients (88 eyelids) with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). In our series, we opted for two-stage surgery in 28 cases : epicanthus-telecanthus surgery followed by ptosis surgery. Simultaneous surgery was performed in 5 cases. RESULTS The mean age at the first visit was 6 years (6.1±6.4). The mean age of our patients at the time of the first surgery was 6.6 years. Epicanthus surgery was performed in 35 cases. The two techniques used to correct epicanthus were Y-V plasty in 30 cases (85.7%, n=35) and Y-V+double Z plasty in 5 cases (14.3%, n=35). Correction of the telecanthus was performed at the same time by a medial canthal tendon plication in 31 cases (88.6%, n=35) or transnasal canthopexy in 4 cases (11.4%, n=35). The mean age at the time of ptosis surgery was 7.23 years (±6.25), ranging from 8 months to 27 years. Ptosis surgery was performed in 41 cases (79 eyelids), of which 3 patients underwent unilateral ptosis surgery due to asymmetrical ptosis. The techniques used were levator resection in 64 eyelids and frontal suspension in 15 eyelids. CONCLUSION BPES is often clinically diagnosed. The difficulty in management lies in the complex surgery required. There is no established consensus regarding surgical techniques or the timing of the surgeries.
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Affiliation(s)
- N Ben Abdesslem
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie.
| | - L Knani
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - W Mili
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - A Mahjoub
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - N Ben Rayana
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - M Ghorbel
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - H Mahjoub
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
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Simmons BA, Clark TJE, Kuiper JJ, Zimmerman BM, Nerad JA, Allen RC, Carter KD, Shriver EM. Closure Technique and Antibiotics in Frontalis Sling Infection and Exposure. Ophthalmology 2020; 128:480-482. [PMID: 32682836 DOI: 10.1016/j.ophtha.2020.06.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Brittany A Simmons
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Thomas J E Clark
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Bridget M Zimmerman
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Jeffrey A Nerad
- Cincinnati Eye Institute, Cincinnati Eye Institute, Cincinnati, Ohio
| | - Richard C Allen
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Keith D Carter
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Erin M Shriver
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.
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Ali AA, Hassan AAM, Salman MS. Surgical Treatment of Severe Ptosis by Modified Brow Suspension Technique. Plast Surg (Oakv) 2020; 28:40-45. [PMID: 32110644 DOI: 10.1177/2292550319880923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Blepharoptosis can occur at any age. Its surgical correction may be indicated for functional and cosmetic purposes. Blepharoptosis treatment in children <3 years old may be required on an urgent basis to prevent amblyopia. The type of surgery depends on the severity of ptosis. The purpose of the study is to assess the functional results and complications of frontalis sling operation using double-threaded prolene as a suspensory material to correct severe ptosis with minimal or no levator muscle function. Methods In total, 72 lids of 59 patients (both male and female) having severe unilateral or bilateral ptosis were included. Frontalis sling with double-threaded prolene using cannula for introducing prolene was used to correct severe ptosis in these patients. Patients were followed up for an average of 21 (range: 12-24) months postoperatively for evaluating the functional and cosmetic results as well as possible complications. Results Favourable long-term functional and cosmetic results were achieved in most patients. The overall recurrence rate of ptosis was in 5 lids, most of which were in <5-year-old patients. Other complications were incomplete closure in 2 lids, overcorrection in 1 lid, and corneal exposure and exposure keratitis in 1 eye. Infection, wound problems, and supratarsal sulcus obliteration were not observed in any case during the follow-up period. Conclusions Frontalis sling operation using double-threaded prolene as a suspensory material is an effective technique to correct severe ptosis.
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Affiliation(s)
- Ali Adawal Ali
- Department of Surgery, College of Medicine, Kirkuk University, Kirkuk, Iraq
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10
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Wang Y, Wu Q, Li L, Liu W, Li C, Fan Y, Cao W, Li N. A modified Fox pentagon technique performed using a polytetrafluoroethylene sling in frontalis suspension to treat blepharophimosis syndrome. Sci Prog 2020; 103:36850419893880. [PMID: 32008456 PMCID: PMC10452787 DOI: 10.1177/0036850419893880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the functional and cosmetic outcomes of a new modified Fox pentagon technique performed using polytetrafluoroethylene in frontalis suspension surgery for blepharophimosis syndrome. This retrospective study enrolled 40 patients diagnosed with blepharophimosis syndrome from March 2016 to October 2018. All patients underwent frontalis suspension using a new modified Fox pentagon technique. The functional and cosmetic outcomes were evaluated. After the operation, the mean palpebral fissure height increased from 2.68 to 6.93 in right eyes and from 2.73 to 6.98 in left eyes. The mean MRD1 increased from 0.53 to 3.76 in right eyes and from 0.50 to 3.78 in left eyes. While preoperative to postoperative differences were statistically significant (p < 0.01), there were no significant differences between right and left eyes either before or after the surgery (p > 0.01). All patients achieved good cosmetic results with an average score of 0.6. We have experimentally created a modified Fox pentagon technique performed using a polytetrafluoroethylene sling in a frontalis suspension to treat BPES; this approach yielded favorable cosmetic and functional outcomes.
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Affiliation(s)
- Yuan Wang
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Qian Wu
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Li Li
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Wen Liu
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Cheng Li
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Yunwei Fan
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - WenHong Cao
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Ningdong Li
- Department of Ophthalmology, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
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Théra JP, Tiama JM, Konipo A, Napo A, Bamani S. [Treatment of congenital ptosis in a low-income country: polypropylene frontalis sling at the African Institute of Tropical Ophthalmology]. J Fr Ophtalmol 2019; 43:123-127. [PMID: 31858999 DOI: 10.1016/j.jfo.2019.07.008] [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: 05/21/2018] [Revised: 04/29/2019] [Accepted: 07/11/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Treatment of congenital ptosis is exclusively surgical; the frontalis sling method is most appropriate when the ptosis is severe, with no upper eyelid levator function. This surgery typically utilizes various materials (autologous fascia lata, silicone, nylon, or polypropylene bands, etc.). MATERIALS AND METHODS This was a retrospective descriptive study of 22 children under 16 years of age, treated for congenital ptosis by frontalis suspension of the levator muscle of the upper eyelid using the polypropylene technique, between January 1, 2014 and June 30, 2017 at the African Institute of Tropical Ophthalmology teaching hospital. RESULTS In our study, the surgical result (prior to correction of recurrences) was satisfactory in 81.82 % of cases, with a recurrence rate of 13.64 %. The mean follow-up was 14 months, ranging from 4 to 25 months. DISCUSSION The use of polypropylene provides encouraging results in ptosis surgery, while also offering the advantage of being low cost and more available. Its use in developing countries deserves special attention.
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Affiliation(s)
- J P Théra
- Ophtalmo-pédiatre, à l'institut d'ophtalmologie tropicale de l'Afrique IOTA, 248, Bamako, Mali.
| | - J M Tiama
- DES d'ophtalmologie à l'institut d'ophtalmologie tropicale de l'Afrique IOTA, 248, Bamako, Mali
| | - A Konipo
- Ophtalmologiste au CSREF de Koulikoro, Mali
| | - A Napo
- Ophtalmologiste à l'institut d'ophtalmologie tropicale de l'Afrique IOTA, 248, Bamako, Mali
| | - S Bamani
- Ophtalmologiste à l'institut d'ophtalmologie tropicale de l'Afrique IOTA, 248, Bamako, Mali
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12
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Rosenberg JB, Andersen J, Barmettler A. Types of materials for frontalis sling surgery for congenital ptosis. Cochrane Database Syst Rev 2019; 4:CD012725. [PMID: 31013353 PMCID: PMC6478334 DOI: 10.1002/14651858.cd012725.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Congenital ptosis is a drooping of one or both eyelids at birth, often due to poor development of the levator palpebrae superioris muscle. This can result in amblyopia, astigmatism, and ocular torticollis and therefore may necessitate surgical intervention in early childhood if visual development is compromised. Patients may have varied levels of levator function. Those with moderate to good function may elect to first attempt ptosis repair with external levator advancement or mullerectomy/Fasanella-Servat procedures. For those with poor function, those procedures are less likely to be effective, so they may undergo frontalis sling surgery, in which the tarsal plate is coupled to the frontalis muscle, so that movement of the brow and forehead result in movement of the eyelid. The optimal material to use in this surgery is unknown. OBJECTIVES To evaluate the comparative effectiveness and safety of various materials used in frontalis sling surgery for congenital ptosis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (June 2018), Ovid MEDLINE, Ovid MEDLINE E-pub Ahead of Print, Ovid Medline In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to 20 June 2018), Embase (January 1947 to 20 June 2018), PubMed (1948 to 20 June 2018), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 20 June 2018), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 20 June 2018. SELECTION CRITERIA We included randomized trials that compared one material to another for the treatment of congenital ptosis. DATA COLLECTION AND ANALYSIS Two review authors independently completed eligibility screening, data abstraction, 'Risk of bias' assessment, and grading of the evidence. MAIN RESULTS We identified three randomized trials that had compared four different materials, two materials in each trial. The studies included a total of 160 participants. The surgical procedures compared were polytetrafluoroethylene (Gore-Tex), Ethibond suture, Mersilene mesh, and autogenous fascia lata.We judged all studies to be at unclear risk of bias due to incomplete reporting of methods and other methodological deficiencies.Because the three included studies compared different types of implants, we were unable to combine data in a meta-analysis. The limited data preclude any conclusion regarding the optimal implant for frontalis sling surgery.In terms of the primary outcome of functional success, this was defined as widening of the opening between eyelids, assessed either by grade or by millimeter measurement. Bajaj 2004 showed that 93% of the Gore-Tex group and 83% of the Ethibond group had a good or satisfactory outcome (as defined by investigators). Elsamkary 2016 reported that 78.1% of the autogenous fascia group and 61.8% of the Gore-Tex group had a very good or good outcome. Salour 2008 did not include this type of grading system; they showed that the lid fissure increased 4.0 mm ± 1.46 mm in the Mersilene group and 3.13 mm ± 1.72 mm in the fascia lata group.In terms of adverse events, Bajaj 2004, which included 15 patients per group, showed no recurrence in the Gore-Tex group and 1 in the Ethibond group; no need for removal in the Gore-Tex group and 1 in the Ethibond group; and no infections in the Gore-Tex group and 1 in the Ethibond group. Elsamkary 2016, which included 55 patients per group, had 3 recurrences in the fascia group and 6 in the Gore-Tex group; no need for removal in either group; and 1 infection in the fascia group and 2 in the Gore-Tex group. Salour 2008, which included 10 patients per group, had no recurrence, removals, or infections in either the Mersilene or the fascia group. AUTHORS' CONCLUSIONS The three trials included in this review evaluated four materials for frontalis sling surgery. Assessment of these three studies does not allow us to identify the optimal material. Future randomized trials should be rigorously designed so as to identify the best treatment for this condition.
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Affiliation(s)
- Jamie B Rosenberg
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Ophthalmology3332 Rochambeau Avenue, 3rd FloorBronxNYUSA10467
| | - James Andersen
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Ophthalmology3332 Rochambeau Avenue, 3rd FloorBronxNYUSA10467
| | - Anne Barmettler
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Ophthalmology3332 Rochambeau Avenue, 3rd FloorBronxNYUSA10467
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Stafford IA, Kopkin RH, Berra AL, Daigle P, Bergeron M, Karlin S, Hodge K, Hagan JL. Efficacy of different cerclage suture materials in reducing preterm birth. J Matern Fetal Neonatal Med 2019; 33:3509-3513. [PMID: 30931657 DOI: 10.1080/14767058.2019.1578744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To compare the efficacy of monofilament suture, braided polyester thread, and 5 mm tape suture in reducing preterm birth (PTB).Study design: Women who received a cerclage at Touro Infirmary, New Orleans, LA, USA, between 1 January, 2011 and 31 December, 2016 were identified using ICD-9/10 codes. All charts were reviewed for demographic and obstetrical variables including gestational age (GA) at delivery.Results: Of 145 women who received a cerclage, 36 were excluded due to incomplete charts leaving 109 for analysis. There was no significant difference in gestational age at cerclage placement or delivery among women with monofilament, braided, or 5 mm tape cerclages (p = .936 and p = .919, respectively) nor was there a difference in the proportion who delivered at ≥32, 34, or 37 weeks across groups with differing cerclage material (p = .270, p = .275, and p = .419, respectively). There was no difference in GA at delivery for patients who received 17-OHP compared to those who did not (p = .362). There were also no differences with respect to birth outcomes such as birthweight (p = .938), Apgar scores (p = .477, p = .430) or neonatal intensive care admission rates (NICU) (p = .304). Analysis revealed no difference in characteristics between groups including history of PTB or indication for removal (p = .371, p = .317).Conclusion: We found no difference in pregnancy prolongation when comparing different suture material used for indicated cerclages. We also found no differences with respect to rates of maternal infection or adverse neonatal outcomes among groups.RationaleThis study was conducted to evaluate the efficacy of different suture materials in increasing gestational age at delivery and reducing preterm birth.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Rachel H Kopkin
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alexandra L Berra
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patrick Daigle
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Michelle Bergeron
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Samantha Karlin
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kimberly Hodge
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Joseph L Hagan
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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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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15
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Al-Salem KM, Al-Salem MK. A novel approach: orbital augmentation using mersilene mesh in seeing eyes. Can J Ophthalmol 2018; 53:e198-e203. [PMID: 30340743 DOI: 10.1016/j.jcjo.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/02/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Khalil M Al-Salem
- Department of Ophthalmology and Visual Sciences, Mutah University, Al-Karak, Jordan.
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16
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Sun J, Liu X, Zhang Y, Huang Y, Zhong S, Fang S, Zhuang A, Li Y, Zhou H, Fan X. Bovine Acellular Dermal Matrix for Levator Lengthening in Thyroid-Related Upper-Eyelid Retraction. Med Sci Monit 2018; 24:2728-2734. [PMID: 29718902 PMCID: PMC5952806 DOI: 10.12659/msm.909306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Eyelid retraction is the most common and often the first sign of thyroid eye disease (TED). Upper-eyelid retraction causes both functional and cosmetic problems. In order to correct the position of the upper eyelid, surgery is required. Many procedures have demonstrated good outcomes in mild and moderate cases; however, unpredictable results have been obtained in severe cases. Dryden introduced an upper-eyelid-lengthening procedure, which used scleral grafts, but outcomes were unsatisfactory. A new technique is introduced in this study as a reasonable alternative for TED-related severe upper-eyelid retraction correction. Material/Methods An innovative technique for levator lengthening using bovine acellular dermal matrix as a spacer graft is introduced for severe upper-eyelid retraction secondary to TED. Additionally, 2 modifications were introduced: the fibrous cords scattered on the surface of the levator aponeurosis were excised and the orbital fat pad anterior to the aponeurosis was dissected and sutured into the skin closure in a “skin-tarsus-fat-skin” fashion. Results The modified levator-lengthening surgery was performed on 32 eyelids in 26 patients consisting of 21 women and 5 men (mean age, 37.8 years; age range, 19–67 years). After corrective surgery, the average upper margin reflex distance was lowered from 7.7±0.85 mm to 3.3±0.43 mm. Eighteen cases (69%) had perfect results, while 6 cases (23%) had acceptable results. Conclusions A modified levator-lengthening procedure using bovine acellular dermal matrix as a spacer graft ameliorated both the symptoms and signs of severe upper-eyelid retraction secondary to TED. This procedure is a reasonable alternative for correction of TED-related severe upper-eyelid retraction.
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Affiliation(s)
- Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Xingtong Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Yidan Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Yazhuo Huang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Sisi Zhong
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Sijie Fang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Ai Zhuang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
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17
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Andersen J, Barmettler A, Rosenberg JB. Types of materials for frontalis sling surgery for congenital ptosis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James Andersen
- Montefiore Medical Center, Albert Einstein College of Medicine; Department of Ophthalmology; 3332 Rochambeau Avenue, 3rd Floor Bronx NY USA 10467
| | - Anne Barmettler
- Montefiore Medical Center, Albert Einstein College of Medicine; Department of Ophthalmology; 3332 Rochambeau Avenue, 3rd Floor Bronx NY USA 10467
| | - Jamie B Rosenberg
- Montefiore Medical Center, Albert Einstein College of Medicine; Department of Ophthalmology; 3332 Rochambeau Avenue, 3rd Floor Bronx NY USA 10467
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18
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Cairó M, Leiva M, Costa D, Peña MT. Modified brow suspension technique for the treatment of pseudoptosis due to redundant frontal skin in the dog: a retrospective study of 25 cases. Vet Ophthalmol 2017; 21:112-118. [DOI: 10.1111/vop.12472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Martí Cairó
- Fundació Hospital Clínic Veterinari; Universitat Autònoma de Barcelona; Bellaterra Spain
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - Marta Leiva
- Fundació Hospital Clínic Veterinari; Universitat Autònoma de Barcelona; Bellaterra Spain
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - Daniel Costa
- Fundació Hospital Clínic Veterinari; Universitat Autònoma de Barcelona; Bellaterra Spain
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - Maria Teresa Peña
- Fundació Hospital Clínic Veterinari; Universitat Autònoma de Barcelona; Bellaterra Spain
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Spain
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Marenco M, Macchi I, Macchi I, Galassi E, Massaro-Giordano M, Lambiase A. Clinical presentation and management of congenital ptosis. Clin Ophthalmol 2017; 11:453-463. [PMID: 28280295 PMCID: PMC5338973 DOI: 10.2147/opth.s111118] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Congenital ptosis is a rare condition characterized by lower positioning of the upper eyelid that is present at birth and is a clinical condition that is persistent if not treated. It may be unilateral or bilateral and may be associated with other ocular disorders or systemic conditions, including Marcus Gunn, Horner, and Duane syndromes. It is a benign condition but causes functional, cosmetic, and psychological problems in children. However, not all patients need to undergo surgery, and usually only patients at risk of amblyopia need a prompt surgical correction, while in other cases, surgery can be postponed. The grade of ptosis, the eyelid function, and the amblyopic risk are the parameters that affect the ophthalmologist’s decision on timing of surgery and the surgical technique to be used. In fact, there are several types of surgical techniques to correct a congenital ptosis, although very often more than one is needed to obtain an acceptable result. This paper reviews the causes of congenital ptosis and associated diseases. Particular emphasis is given to surgical management and different procedures available to correct the upper eyelid anomaly and avoid permanent damage to visual function.
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Affiliation(s)
- Marco Marenco
- Department of Sense Organs, University of Rome "Sapienza"
| | - Ilaria Macchi
- Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome
| | - Iacopo Macchi
- Department of Ophthalmology, University of Catania, Catania
| | - Emilio Galassi
- Ophthalmic Clinic, Department of Ophthalmology, University of L'Aquila, L'Aquila, Italy
| | - Mina Massaro-Giordano
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
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20
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Kindinger LM, Kyrgiou M, MacIntyre DA, Cacciatore S, Yulia A, Cook J, Terzidou V, Teoh TG, Bennett PR. Preterm Birth Prevention Post-Conization: A Model of Cervical Length Screening with Targeted Cerclage. PLoS One 2016; 11:e0163793. [PMID: 27812088 PMCID: PMC5094773 DOI: 10.1371/journal.pone.0163793] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 09/14/2016] [Indexed: 11/18/2022] Open
Abstract
Women with a history of excisional treatment (conization) for cervical intra-epithelial neoplasia (CIN) are at increased risk of preterm birth, perinatal morbidity and mortality in subsequent pregnancy. We aimed to develop a screening model to effectively differentiate pregnancies post-conization into low- and high-risk for preterm birth, and to evaluate the impact of suture material on the efficacy of ultrasound indicated cervical cerclage. We analysed longitudinal cervical length (CL) data from 725 pregnant women post-conization attending preterm surveillance clinics at three London university Hospitals over a ten year period (2004-2014). Rates of preterm birth <37 weeks after targeted cerclage for CL<25mm were compared with local and national background rates and expected rates for this cohort. Rates for cerclage using monofilament or braided suture material were also compared. Of 725 women post-conization 13.5% (98/725) received an ultrasound indicated cerclage and 9.7% (70/725) delivered prematurely, <37weeks; 24.5% (24/98) of these despite insertion of cerclage. The preterm birth rate was lower for those that had monofilament (9/60, 15%) versus braided (15/38, 40%) cerclage (RR 0.7, 95% CI 0.54 to 0.94, P = 0.008). Accuracy parameters of interval reduction in CL between longitudinal second trimester screenings were calculated to identify women at low risk of preterm birth, who could safely discontinue surveillance. A reduction of CL <10% between screening timepoints predicts term birth, >37weeks. Our triage model enables timely discharge of low risk women, eliminating 36% of unnecessary follow-up CL scans. We demonstrate that preterm birth in women post-conization may be reduced by targeted cervical cerclage. Cerclage efficacy is however suture material-dependant: monofilament is preferable to braided suture. The introduction of triage prediction models has the potential to reduce the number of unnecessary CL scan for women at low risk of preterm birth.
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Affiliation(s)
- Lindsay M Kindinger
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Maria Kyrgiou
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David A MacIntyre
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Stefano Cacciatore
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Angela Yulia
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - Joanna Cook
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Vasso Terzidou
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - T G Teoh
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Phillip R Bennett
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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21
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Chung HW, Seah LL. Cosmetic and functional outcomes of frontalis suspension surgery using autologous fascia lata or silicone rods in pediatric congenital ptosis. Clin Ophthalmol 2016; 10:1779-1783. [PMID: 27695282 PMCID: PMC5033495 DOI: 10.2147/opth.s113814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Cosmetic and functional outcomes of frontalis suspension surgery using autologous fascia lata (FL) or silicone rods (SRs) in pediatric congenital ptosis. DESIGN Retrospective case series. STUDY SUBJECTS Patients with congenital ptosis, aged 18 years or younger, during the period under study (2005-2011) at the Singapore National Eye Centre. METHODS Review of case records for functional and cosmetic outcome measures after frontalis suspension surgery using either SRs or autologous FL. RESULTS A total of 18 patients were studied (14 eyelids had FL, 16 eyelids had SRs) with mean ages of 7.1 (range 5-12) and 7.2 (range 4-18) years for the FL and SR groups, respectively. Mean follow-up period was 41.6 (range 11.2-77.9) and 48.6 (16.1-87.4) months, respectively. Patients in the FL group had better functional and cosmetic results compared to those in silicone group, with no recurrence of ptosis. More complications were experienced by patients in the SR group. CONCLUSION Autologous FL for frontalis suspension remains an excellent choice for (and should be considered as useful surgical armamentarium for) repair of severe congenital ptosis.
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Affiliation(s)
- Hsi-Wei Chung
- Department of Ophthalmology, Singapore National Eye Centre; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Lay Leng Seah
- Department of Ophthalmology, Singapore National Eye Centre; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
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22
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Pacella E, Mipatrini D, Pacella F, Amorelli G, Bottone A, Smaldone G, Turchetti P, La Torre G. Suspensory Materials for Surgery of Blepharoptosis: A Systematic Review of Observational Studies. PLoS One 2016; 11:e0160827. [PMID: 27631781 PMCID: PMC5025102 DOI: 10.1371/journal.pone.0160827] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. OBJECTIVES The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. DATA SOURCE AND METHODS Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. RESULTS The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. CONCLUSIONS Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results.
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Affiliation(s)
- Elena Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Daniele Mipatrini
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza, University of Rome, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Giulia Amorelli
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Andrea Bottone
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Gianpaolo Smaldone
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Paolo Turchetti
- National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza, University of Rome, Rome, Italy
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Kindinger LM, MacIntyre DA, Lee YS, Marchesi JR, Smith A, McDonald JAK, Terzidou V, Cook JR, Lees C, Israfil-Bayli F, Faiza Y, Toozs-Hobson P, Slack M, Cacciatore S, Holmes E, Nicholson JK, Teoh TG, Bennett PR. Relationship between vaginal microbial dysbiosis, inflammation, and pregnancy outcomes in cervical cerclage. Sci Transl Med 2016; 8:350ra102. [DOI: 10.1126/scitranslmed.aag1026] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/23/2016] [Indexed: 12/20/2022]
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The Mechanics of Brow-Suspension Ptosis Repair: A Comparative Study of Fox Pentagon and Crawford Triangle Techniques. Ophthalmic Plast Reconstr Surg 2016; 33:22-26. [PMID: 26808175 DOI: 10.1097/iop.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To perform quantitative analysis of the most commonly used brow-suspension configurations. METHODS The inflection positions for Fox pentagon and Crawford triangle configurations were marked on 49 healthy volunteers (male and female) and photographs taken in 3 states: "normal," "closed," and "raised." The skin marks were measured vectorially with respect to the medial canthus, and displacement changes were evaluated for "normal-to-closed" ("blinking") and from "closed-to-raised" ("eye-opening") states. The distance between a pair of inflection marks, representing the approximate path of sling configurations, were also measured and analyzed in relation to the mechanical properties of a variety of synthetic brow-suspension materials. RESULTS "Blinking" resulted in the greatest displacement in the medial eyelid incision, resulting in the greatest strain on the line connecting the medial eyelid and medial brow inflections. No significant differences in the strains for individual lines were found between the Fox and Crawford techniques, although the former shows a significantly lower overall strain in the whole loop than the latter. The displacements of some inflections and of the strains of a few lines differed significantly in men and women. CONCLUSIONS Within the scope of this study, the blinking action was shown to result in the maximum strain of ~40%, which lies within the elastic region of stress-strain curves for some commonly used synthetic brow-suspension materials. No one method was statistically superior, although the Fox pentagon gave a significantly lower overall strain when the sling material was assumed to move somewhat around the inflections within a closed loop.
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Jan-Bond C, Norazah AR, Sree-Kumar P, Zunaina E, Fazilawati Q. Infected ptosis surgery - a rare complication from a multidrug-resistant organism. Clin Ophthalmol 2015; 9:721-4. [PMID: 25945032 PMCID: PMC4407742 DOI: 10.2147/opth.s81158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 7-year-old boy had a case of congenital ptosis of the right eye and has undergone frontalis sling surgery using Gore-tex material. There was no intraoperative or immediate postoperative complication. However, the patient defaulted his follow-up and presented with right eye preseptal abscess secondary to infected surgical wound 1 month after surgery. He was treated with multiple antibiotics and underwent repeated incision and drainage procedures. However, there was still no resolution of the right eye preseptal abscess. The patient’s condition subsequently improved after removal of the Gore-tex material and treatment with an antibiotic combination of ceftazidime and amikacin. Microbiological analysis finally isolated the multidrug resistant Acinetobacter species. At 6 months follow-up, his right upper eyelid was healed with scarring, but without ptosis.
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Affiliation(s)
- Chan Jan-Bond
- Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves, Selangor, Malaysia ; Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Abdul-Rahman Norazah
- Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves, Selangor, Malaysia
| | - Palani Sree-Kumar
- Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves, Selangor, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Qamarruddin Fazilawati
- Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves, Selangor, Malaysia
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Abstract
PURPOSE Frontalis suspension is the treatment of choice for severe blepharoptosis with poor levator function. Several materials are available for this purpose. Autologous fascia lata is considered best among naturally occurring materials; however, it may not be possible to harvest fascia lata in young children. Among various synthetic materials, silicone has been used frequently and has given good results. METHODS This is a retrospective analysis of patients operated on from September 2008 to August 2013. All of these patients underwent silicone rod frontalis suspension for severe blepharoptosis with poor levator function and completed a minimum of 6 months of follow-up. RESULTS There were 38 eyes of 25 patients with ages ranging from 3 to 21 years (average: 10.68 ± 6.26 years). Of these 25 patients, 10 had blepharophimosis syndrome, 10 had congenital ptosis, 3 had third nerve palsy, 1 had double elevator palsy, and 1 had post-levator resection. Good cosmetic correction was achieved in 34 eyes (89.4%) after a mean follow-up of 18 months (range: 6 to 60 months). Complications observed included significant eyelid lag and lagophthalmos (5 eyes), undercorrection (4 eyes), suture granuloma (3 eyes), sling exposure at forehead incision (3 eyes), bilateral chronic eyelid edema (1 patient), and late recurrence of ptosis (1 eye). CONCLUSIONS Silicone is a safe material for frontalis suspension in patients with severe ptosis; however, recurrence, granuloma formation, sling exposure, and chronic inflammation can occur with use of silicone rod.
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Israfil-Bayli F, Toozs-Hobson P, Lees C, Slack M, Ismail K. Cerclage outcome by the type of suture material (COTS): study protocol for a pilot and feasibility randomised controlled trial. Trials 2014; 15:415. [PMID: 25348257 PMCID: PMC4221668 DOI: 10.1186/1745-6215-15-415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical incompetence is one of the causes of preterm birth and mid-trimester pregnancy loss. Cervical cerclage is a surgical procedure to treat cervical incompetence. Cervical cerclage reduces the incidence of preterm birth in women at risk of recurrent preterm birth, without a statistically significant reduction in perinatal mortality or neonatal morbidity. Multifilament/braided sutures such as Mersilene tape have been traditionally used for cervical cerclage. Braided sutures, particularly mesh-like non-absorbable sutures, have been associated with an increased risk of infection and, hence, some obstetricians prefer to use monofilament/non-braided sutures. However, these claims are not substantiated by any scientific or clinical evidence.We propose a pilot/feasibility study which will provide the necessary information for planning a definitive trial investigating the clinical effectiveness of monofilament non-braided suture materials in reducing pregnancy loss rate following cervical cerclage compared to the traditional multifilament braided sutures. METHODS/DESIGN Women eligible for elective or ultrasound-indicated cerclage at 12 to 21 + 6 weeks of gestation will be randomised to having the procedure using either a monofilament non-braided suture (Ethilon) or a Multifilament braided suture (Mersilene tape) inserted using a McDonald technique. Consent for participation in the Cerclage outcome by the type of suture (COTS) study will be obtained from each eligible participant. CLINICAL TRIALS REGISTRATION COTS is registered with the International Standard Research for Clinical Trials (ISRCTN17866773). Registered on 27 March 2013.
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Affiliation(s)
- Fidan Israfil-Bayli
- />Birmingham Women’s Hospital NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG UK
| | - Philip Toozs-Hobson
- />Urogynaecology Department, Birmingham Women’s Hospital NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG UK
| | - Christoph Lees
- />Imperial Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS UK
| | - Mark Slack
- />Urogynaecology Department, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 2QQ UK
| | - Khaled Ismail
- />School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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Bouazza M, Elbelhadji M, Mchachi A, Benhmidoune L, Amraoui A. Traitement du ptosis congénital par suspension au muscle frontal par fil de polypropylène : résultats d’une étude de 21 cas. J Fr Ophtalmol 2014; 37:520-5. [DOI: 10.1016/j.jfo.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/02/2014] [Accepted: 01/22/2014] [Indexed: 11/25/2022]
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Cagatay HH, Ekinci M, Apil A, Arslan B, Pamukcu C, Oba ME, Demir M. The use of polypropylene suture as a frontalis suspension material in all age groups of ptosis patients. J INVEST SURG 2014; 27:240-4. [PMID: 24661265 DOI: 10.3109/08941939.2014.892187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/AIM To evaluate the use of 2-0 polypropylene suture for frontal suspension in ptosis patients with poor levator function. MATERIALS AND METHODS This retrospective study included 20 eyelids of 16 patients (5 female, 11 male) with 4 mm or less levator function. The operation was considered successful when the difference between the two upper lids was ≤ 1 mm, and the upper lid covered the upper limbus by <3 mm. RESULTS Median patient age was 22.94 years (2 to 59). Mean follow-up time was 18.06 months (12-29). A successful result was obtained in 14 patients (87.5%). Ptosis recurrence was observed in two patients (12.5%). Lagophthalmos with punctate epithelial keratitis and subsequent spontaneous recovery occurred during the first postoperative week in six patients (37.5%). Two patients with hypocorrection underwent revision surgery in the first postoperative week. Granuloma and material exposition at the forehead incision site observed in one patient at the postoperative fifth month were repaired by excision of the granuloma and suture reposition. CONCLUSIONS Polypropylene suture as a frontalis suspension material in ptosis patients with poor levator function maintained satisfactory results at follow-up. This material allows easy and repeatable eyelid height adjustment and does not obviate future eyelid procedures.
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Frontalis suspension with supramid suture: longevity results in very young patients with congenital ptosis. Ophthalmic Plast Reconstr Surg 2014; 30:110-5. [PMID: 24618905 DOI: 10.1097/iop.0000000000000014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the duration of effect of frontalis suspension using Supramid suture (polyfilament, cable-type 3-0 suture) technique in very young children with congenital ptosis. METHODS The authors performed a retrospective review of 44 patients aged 4 years or less who underwent frontalis suspension using Supramid at the Bascom Palmer Eye Institute. Surgical success was defined as good eyelid height and position. Duration of the sling was defined as the time from initial surgery until additional surgery was performed or the date of last follow up. Kaplan-Meier survival analysis was performed with failure time measured as time from initial surgery until additional surgery was performed. RESULTS Kaplan-Meier survival analysis showed a success rate of 87.5% at 1 year, 78.2% at 2 years, 74.5% at 3 years, 58.2% at 4 years, and 53.7% at 5 years. Complications were noted in 10 cases (23%) and included damage to the Supramid sling secondary to trauma and granuloma formation. CONCLUSIONS Given the ready availability, ease of placement, and reliable cosmetic and functional results, Supramid suture is an excellent temporizing treatment option in cases of early amblyogenic congenital ptosis in children <4 years of age. Due to the inherent decline in effect over time and likely need for a secondary procedure at a later age, however, they do not recommend this as an alternative to other sling materials, such as autogenous fascia lata, in patients over 4 years of age.
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Kwon KA, Shipley RJ, Edirisinghe M, Ezra DG, Rose GE, Rayment AW, Best SM, Cameron RE. Microstructure and mechanical properties of synthetic brow-suspension materials. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 35:220-30. [DOI: 10.1016/j.msec.2013.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/02/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022]
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Israfil-Bayli F, Toozs-Hobson P, Lees C, Slack M, Daniels J, Vince A, Ismail KMK. Cervical cerclage and type of suture material: a survey of UK consultants’ practice. J Matern Fetal Neonatal Med 2014; 27:1584-8. [DOI: 10.3109/14767058.2013.870551] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Evaluation of Safety and Efficacy of Silicone Rod in Tarsofrontalis Sling Surgery for Severe Congenital Ptosis. Ophthalmic Plast Reconstr Surg 2014; 30:11-4. [DOI: 10.1097/iop.0b013e3182a74f44] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bladen JC, Moosajee M, Tumuluri K, Olver JM. The use of a pleated strip of autogenous temporalis fascia graft for frontalis suspension in recurrent poor levator function ptosis in adult patients. Orbit 2012; 31:114-8. [PMID: 22489854 DOI: 10.3109/01676830.2011.648805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Poor levator function (LF) blepharoptosis can be corrected surgically using frontalis muscle suspension with a variety of materials. Autogenous grafts such as fascia lata are commonly used. The need for a remote surgical site and the risk of an unattractive leg scar makes the use of an autogenous temporalis fascia (ATF) graft appealing as the scar is concealed in the hair. We describe the use of a pleated, lengthened ATF graft that is easy to prepare and insert, and provides a cosmetically acceptable outcome. METHODS Prospective case series describing six patients with previous multiple failed lid surgeries and recurrent poor (≤ 5 mm) LF (mean 2.87 ± 1.72 mm) ptosis. The pleated graft technique was used to yield a strip of ATF up to 18-cm long from a short 2-cm temporal incision. Eight eyelids then underwent ATF graft frontalis suspension surgery using the modified Fox pentagon technique. Outcomes included eyelid measurements with 4.5-year follow-up. RESULTS All patients achieved good functional and esthetic outcome. The mean central palpebral aperture 6 weeks postsurgery was 7.14 ± 1.67 mm, equating to a mean increase of 3.27 mm (p < 0.05 using the paired t-test). The improvement in eyelid height was maintained at the 4.5-year follow-up in all patients, except one who died of unrelated cause. CONCLUSION A pleated strip of ATF graft provides a simpler alternative to fascia lata grafting for frontalis suspension in poor LF ptosis in adult patients with good long-term results.
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The open sky approach to brow suspension surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Di Rosa L, Pirrello R, Russa G, Carita S, Morreale Bubella D, Lodato G. Deep levator palpebrae superioris detachment during aponeurosis surgery via transcutaneous approach in ptosis correction. J Fr Ophtalmol 2011; 35:166-9. [PMID: 22172368 DOI: 10.1016/j.jfo.2011.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 05/22/2011] [Accepted: 06/03/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the efficacy of deep levator palpebrae superioris - Müller's muscle complex detachment from conjunctiva and other connective tissues in order to improve post operative lid opening and levator function for ptosis surgery via the transcutaneous approach. METHODS In this retrospective study, 23 patients (29 eyelids) were surgically treated for ptosis repair between 2003 and 2008. All surgery was performed by the same surgeon. Patients were divided into 2 groups. The first group (12 patients) consisted of patients who underwent deep levator dissection during surgery; the second group (11 patients), used as control group, consisted of patients treated without deep levator dissection. Postoperative lid opening was compared in the two groups using the Mann-Whitney non-parametric test. RESULTS The comparison between change in lid opening changes between the two groups was statistically significant (P<0.01). CONCLUSIONS Deep levator detachment can be included among standard surgical steps during ptosis surgery via transcutaneous approach in order to improve postoperative lid opening and levator function.
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Affiliation(s)
- L Di Rosa
- University eye hospital, Via Liborio Giuffre' 13, 90127 Palermo, Italy.
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Choi S, Shin JH, Cheong Y, Lee HJ, Jin KH, Park HK. Nanostructural investigation of frontalis sling biomaterial surfaces. SCANNING 2011; 33:419-425. [PMID: 21538393 DOI: 10.1002/sca.20233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 04/05/2011] [Indexed: 05/30/2023]
Abstract
This study examined the nanostructural surface of three frontalis sling biomaterials: autogenous fascia lata, preserved fascia lata and silicone rod. The morphological characteristics of the sling biomaterial surfaces were examined qualitatively and quantitatively by scanning electron microscopy and atomic force microscopy, respectively. The autogenous fascia lata showed well-arranged nanostructures of parallel fascia collagen fibrils with clear 67 nm axial periodicity, whereas the preserved fascia lata showed tangled nanostructures of damaged collagen fibril bundles. The silicone rod showed a substantial amount of debris with some scratches and the smoothest roughness compared with the other sling biomaterials, followed by preserved fascia lata. Autogenous fascia lata showed the highest surface roughness. The association between the roughness and cell adhesion suggests that the nanostructure of autogenous fascia lata biomaterials is the best for frontalis sling and that of the silicone rod biomaterials is the worst.
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Affiliation(s)
- Samjin Choi
- Department of Biomedical Engineering & Healthcare Industry Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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A new way to bridge frontalis muscle and tarsal plate. Ophthalmic Plast Reconstr Surg 2011; 27:309; author reply 309-10. [PMID: 21747271 DOI: 10.1097/iop.0b013e31821d85fd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIM The aim of this study was to assess the efficacy of frontalis suspension using 4-0 prolene sutures for paediatric ptosis with poor levator function. PATIENTS AND METHODS A retrospective chart review was performed on children who underwent 4-0 prolene frontalis suspension from 2000 to 2008 with a minimum of 6 months' follow-up. Functional success was defined when three criteria were met: (a) satisfactory lid height (defined as margin-to-reflex distance ≥3 mm with minimal frontalis muscle tone); (b) satisfactory lid symmetry (≤2 mm asymmetry in margin-to-reflex distance); and (c) satisfactory cosmesis. Recurrence was defined by a drop in lid height of ≥3 mm from the initial post-operative level. RESULTS A total of 23 patients (30 eyelids) were included. The mean follow-up duration was 28.7 months (range 6.3 to 100 months). The functional success rate was 74% (17/23 patients). Ptosis recurred in 22% (5/23) of patients. Only one patient (4%) developed a complication: a case of minor wound infection. CONCLUSIONS In paediatric ptosis with poor levator function, prolene frontalis suspension has good efficacy and an excellent safety profile. The results of prolene frontalis suspension are comparable to those of other non-autogenous materials.
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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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Atherton DD, Joshi N, Kirkpatrick N. Augmentation of temporal fossa hollowing with Mersilene mesh. J Plast Reconstr Aesthet Surg 2010; 63:1629-34. [DOI: 10.1016/j.bjps.2009.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 09/20/2009] [Indexed: 11/29/2022]
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Wei YH, Liao SL. Frontalis suspension using expanded polytetrafluoroethylene: results of different surgical designs. J Formos Med Assoc 2010; 108:943-9. [PMID: 20040459 DOI: 10.1016/s0929-6646(10)60007-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE Several surgical designs and materials have been proposed for frontalis suspension for treating congenital ptosis and ptosis with poor levator muscle function. This study evaluated the surgical results of frontalis suspension using expanded polytetrafluoroethylene (ePTFE) with two different surgical designs (open-type and closed-type). METHODS We reviewed the medical records of 96 patients (68 children and 28 adults) who underwent frontalis suspension surgery using ePTFE. Postoperative eyelid position, ptosis recurrence, and complications were recorded. RESULTS Twenty-eight out of 68 children and all 28 adults underwent closed-type frontalis suspension surgery, and 40 children underwent open-type surgery. The recurrence rate was 20% (8 of 40 eyelids) for children with closed-type surgery, and 2% (1 of 50 eyelids) for those with open-type surgery. There was a statistically significant difference in the recurrence rate between the two surgical methods in children (p = 0.011). The recurrence rate was 5% (2 of 40 eyelids) in adults who underwent the closed-type method. The recurrence rate after closed-type surgery was significantly different between the child and adult groups (p = 0.04). CONCLUSION Open-type frontalis suspension surgery using ePTFE is preferable to closed-type surgery for children with upper eyelid ptosis. Closed-type surgery provides more favorable results in adults than in children.
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Affiliation(s)
- Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Chong KKL, Fan DSP, Lai CHY, Rao SK, Lam PTH, Lam DSC. Unilateral ptosis correction with mersilene mesh frontalis sling in infants: thirteen-year follow-up report. Eye (Lond) 2009; 24:44-9. [PMID: 19300466 DOI: 10.1038/eye.2009.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess surgical, visual, refractive, and aesthetic outcomes 13 years after mersilene mesh frontalis sling (MMFS) operation for severe unilateral congenital ptosis performed in 10 infants before 1 year of age. METHODS Longitudinal follow-up of an interventional case series by structured ocular examinations, external photographs, and questionnaire-based interviews. RESULTS Mean age at surgery was 6.9+/-2.7 months. After a mean follow-up of 13.0+/-0.6 years, one patient (10%) had recurrent ptosis with the upper lid 2 mm below the superior limbus at 3 months postoperatively. Best-corrected visual acuities were within two Snellen lines between the two eyes in all patients. Astigmatic errors were 1.20+/-1.00 D and 1.10+/-1.70 D between operated and unoperated eyes. Four patients had 2 mm lid lag on down-gaze and one of them had 2 mm lagophthalmos. Mean satisfaction scores (scale of 1 to 100) for lid position, cosmesis, function, and to the procedure were 83.3+/-11.8, 77.0+/-22.9, 89.4+/-5.5, and 86.8+/-6.3, respectively. No case of overcorrection, sling extrusion, stitch granuloma, or exposure keratopathy was noted. CONCLUSIONS In view of the low recurrence rate (10%) and absence of serious complication or need for revision after 13 years, the use of MMFS seems effective and feasible in infants less than 1 year old. Achieving compatible long-term stability, satisfactory aesthetic, and visual outcomes, MMFS may offer an alternative to delaying operations for autogenous fascia lata harvesting in infants requiring early ptosis correction.
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Affiliation(s)
- K K L Chong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, PRC
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Frontalis Suspension Sling Using Palmaris Longus Tendon in Chronic Progressive External Ophthalmoplegia. Ophthalmic Plast Reconstr Surg 2009; 25:140-1. [DOI: 10.1097/iop.0b013e31819ac542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Electroretinograms in three cases of Creutzfeldt-Jakob disease with visual disturbances. Jpn J Ophthalmol 2009; 53:31-34. [PMID: 19184306 DOI: 10.1007/s10384-008-0608-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To report three cases of idiopathic Creutzfeldt-Jakob disease (CJD) with visual symptoms. CASES Patient 1 initially visited our ophthalmology department complaining of blurred vision. Electro-retinography (ERG) showed a selective reduction of the b wave before she was diagnosed with CJD. Patient 2 had normal ERG results even with severely advanced CJD. However, a reduction of the b wave on ERG was observed 1 month before the patient died. Patient 3 had visual disturbances at the initial visit, but the ERG result was normal even after the CJD had advanced. Atrophy of the visual cortex was later observed. OBSERVATIONS CJD can alter the vision in various ways. The selective reduction of the b wave on ERG indicates the retinal involvement. However, visual disturbances may occur without the retinal implications. CONCLUSION Ophthalmologists should be aware that the visual impairment can be the first symptom of CJD.
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Salour H, Aletaha M, Bagheri A. Comparison of Mersilene mesh and autogenous fascia lata in correction of congenital blepharoptosis: a randomized clinical trial. Eur J Ophthalmol 2009; 18:853-7. [PMID: 18988153 DOI: 10.1177/112067210801800601] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To asses the functional results and complications of Mersilene mesh as an alternative to autogenous fascia lata in the management of low function ptosis. METHODS In a randomized clinical trial, 31 eyelids with poor levator function were operated on. In 16 eyelids Mersilene mesh (Group A) and in 15 eyelids autogenous fascia lata were used for frontalis suspension procedure (Group B). RESULTS Nine patients with congenital unilateral and 11 patients with bilateral ptosis underwent sling procedure. There were no differences between the two groups with regards to functional (lid fissure height stability) and cosmetic (lid margin contour) results. Eyelid fissure increase was 4.00-/+1.46 mm in Group A and 3.13-/+1.72 mm in Group B. Change in eyelid fissure in both groups was significant (p=0.00, paired t-test), but intergroup difference was not significant (p=0.141, independent sample t-test). Follow-up for Group A was 14.2 (range 6-26) months and for Group B was 15.1 (range 9-29) months. Dermatochalasis was seen more in Group B (B/A = 10/2) and extrusion of Mersilene mesh was seen in two cases of Group A and none of Group B. Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the two groups. CONCLUSIONS Mersilene mesh with long-term functional results and low rate of complications is a suitable alternative to autogenous fascia lata as a suspensory material in ptosis surgery.
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Affiliation(s)
- H Salour
- Department of Ophthalmology and Research Center, Labbafinejad Medical Center, Shahid Beheshti Medical Sciences University, Tehran - Iran.
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Frontalis Sling Operation Using Silicone Rod Compared with Preserved Fascia Lata for Congenital Ptosis. Ophthalmology 2009; 116:123-9. [DOI: 10.1016/j.ophtha.2008.08.049] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 08/22/2008] [Accepted: 08/22/2008] [Indexed: 11/24/2022] Open
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