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Mahsa Sohrab, Gary Lissner; Comparison of Fasanella-Servat and Small-Incision Techniques for Involutional Ptosis Repair. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6376.
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To compare small-incision external approach and classic Fasanella-Servat internal approach (including tarsus resection) for correction of upper eyelid involutional ptosis.
Retrospective review of medical records of 93 patients (104 surgical procedures) evaluated at the Northwestern University Department of Ophthalmology between December 2008 to 2011, all of whom underwent small-incision or classic Fasanella-Servat technique ptosis repairs by the same surgeon (GSL). Main outcome measures included patient satisfaction, marginal reflex distance one (MRD1), surgical complications, operating time.
Of the 93 patients, 67% (62/93) were female and 33% (31/93) were male, with overall average age of 69 (+/-14). Of the surgical procedures, 48% (50/104) were small-incision external approaches and 52% (54/104) were Fasanella-Servat internal approaches. Average length of post-operative follow-up was 34.0 days overall (+/-16.0), 32.4 days (+/-17.2) for the Fasanella-Servat group and 38.4 days (+/-15.3) for the small-incision group. MRD1 increased an average of 3.38 mm (+/-0.79) in the Fasanella-Servat group and 2.79 mm (+/-0.8) in the small incision group, and the difference was statistically significant (p<0.001). Pre-operative MRD1 was lower in the Fasanella-Servat group (-0.81 +/- 0.75 versus -0.30 +/-0.43, p<0.001), but post-operative MRD1 was similar between the two groups (2.57 +/-0.54 versus 2.49 +/- 0.56, p=0.5). Average operating time was 53 minutes (+/- 16) in the small incision group and 27 minutes (+/- 6 minutes) in the Fasanella-Servat group (p<0.001). In the Fasanella-Servat group, 61% of patients (33/54) experienced pain on post-operative day one versus 32% of patients (16/50) in the small-incision group (p=0.01). There were no surgical complications in either group with equivalent patient satisfaction between the two groups.
Both the classic Fasanella-Servat internal approach and the small incision external approach lead to good surgical outcomes with equivalent patient satisfaction for cases of involutional ptosis, although the classic Fasanella-Servat approach provides a shorter average operating time with equivalent post-operative MRD1.
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