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Jacqueline K. Ng, John Ng; Modified Frontalis Sling with Lash Repositioning in Pediatric Ptosis Repair. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6751.
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© ARVO (1962-2015); The Authors (2016-present)
To describe and report results of a modified frontalis suspension technique utilizing silicone rods with direct fixation to tarsus and lash margin rotation in a rhomboidal configuration in the pediatric population.
Retrospective chart review from 2003-2011 of patients of one primary surgeon utilizing the modified frontalis suspension technique.
A total of 70 patient charts were reviewed with 64 eyelids of 49 patients included. Age ranged from 6 weeks to 17 years (median age of 17 months). The indications for surgery included congenital ptosis in 41 eyelids (64.1%), blepharophimosis in 10 eyelids (15.6%), cranial nerve III palsy in 9 eyelids (14.1%), jaw winking ptosis in 2 eyelids (3.1%), and Dubowitz syndrome in 2 eyelids (3.1%).Average follow-up was 17.8 months (range 1 day to 75 months), with 1 patient lost to follow-up. A successful correction was defined as a marginal reflex distance 1 (MRD1) of at least 2mm with maximum frontalis muscle effort, and no more than 1mm difference in asymmetry between fellow eyes. 15 eyelids (23.4%) of 13 patients required revision. The median age of revision was 14 months (range 1 month to 7 years). Of these, 11 eyelids (73.3%) had an original diagnosis of congenital ptosis, 2 eyelids (13.3%) with blepharophimosis, 1 eyelid (6.7%) with jaw winking ptosis, and 1 eyelid (6.7%) with cranial nerve III palsy. Revision of 9 eyelids was due to recurrent ptosis. Other indications for revision included 1 case of brow ptosis, 1 case of concurrent hypotropia repair, 2 cases of decreased frontalis muscle effort, and 2 cases due to trauma. All cases were revised with silicone except in 1 case with tutoplast, and 1 case with fascia lata.Complications following the silicone revisions included 2 cases of lash ptosis, and 1 case of dry eyes. In cases without revision, complications included 1 lid with suture granuloma requiring incision and drainage procedure, 1 lid with intermittent exposure of sling not requiring further intervention, and 3 lids with lagophthalmos.
In this study, the recurrence rate of pediatric ptosis requiring revision with the modified frontalis sling procedure was similar to prior studies (23.4%), with the majority of cases being congenital ptosis with recurrent ptosis being the most often indication for revision. In this study, a trend for recurrent ptosis was noted with early repair within 2 years of age. Repeat silicone procedure in these cases was found to be effective. With the intentional lash margin rotation, there was improved cosmesis and only limited incidences of lash ptosis in the revision cases. Thus, the modified frontalis sling procedure is a robust technique with few complications that can be employed in congenital ptosis repairs.
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