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R.S. Lucas, G.J. Ben Simon, A.A. McNab; Outcome Of Frontalis Suspension Surgery Using Autogenous Fascia Lata For Congenital Ptosis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):723.
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To evaluate the safety and efficacy of frontalis suspension surgery using autogenous fascia lata for congenital ptosis
Retrospective medical record review and questionnaire of all patients who underwent frontalis suspension surgery (using autogenous fascia lata) for congenital ptosis with poor levator function or ptosis associated with blepharophimosis. Data retrieved included comprehensive eye examination, eyelid position, levator function, surgical outcome and patient satisfaction. Main outcome measures: Eyelid position, eyelid symmetry (upper eyelid heights within 1mm), post–operative complications and re–operation rate.
33 patients (21 males, mean age of 6.5 ± 4.3 years, range 1 to 15) underwent 48 frontalis suspension surgeries for congenital upper eyelid ptosis. 15 patients underwent bilateral surgery; mean follow up time was 39 months. Pre–operatively patients had marked ptosis with a mean MRD value of –0.6mm (±1.5), eyelid asymmetry of 2.2mm (±1.6) and 18 patients with chin–up position. Post–operatively, eyelid asymmetry improved to 1mm (±1.3), P=0.036 (paired samples t test), and only two cases had persistent chin up position. 81% of all cases achieved good or excellent eyelid position; seven patients (14.6%) required re–operation for residual or recurrent upper eyelid ptosis. Visual acuity did not change with surgery (average 6/7.5). Complications included haematoma in two cases and suture pustule in one case; both resolved with conservative treatment.
Frontalis suspension surgery for congenital ptosis using autogenous fascia lata is safe and effective in achieving good eyelid position. Re–operation rate is relatively low and may represent the natural history of congenital ptosis.
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