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Jason M. Moss, Soosan Jacob, Amar Agarwal, Roman Shinder; Single Suprabrow Incision Frontalis Sling Procedure for the Surgical Correction of Ptosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1032.
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Frontalis sling surgery has become a mainstay for the treatment of ptosis from various etiologies with a multitude of procedural variations described. While most provide for good functional repair, the need for multiple incisions and sutures has hampered cosmetic outcomes previously. Here we describe a novel single-incision frontalis sling procedure using a Seiff silicone suspension set for the treatment of poor levator function ptosis.
Charts of 13 patients who underwent the following procedure were reviewed. Following skin marking a fox pentagon, local anesthesia and sterile draping of the surgical field, a single stab incision to the periosteum at the superior brow margin directly over the midpupillary point was made. One 20-gauge rod of the Seiff silicone suspension set was inserted just above the lid margin medially and advanced laterally through the preseptal plane to emerge above the lid margin laterally (Fig 1B). The rod was reintroduced through the lateral exit site and advanced within the muscle plane superolaterally towards the orbital rim (Fig 1C). There it was again redirected and advanced medially to emerge through the previously created stab incision (Fig 1D) An identical procedure was performed with the other rod passed through the medial lid margin site and emerging through the stab incision (Fig 1E) Both ends of the tubing set were secured together with a silicone sleeve (Fig 1F), which was then buried in the suprbrow incision and closed with a single suture.
7 male and 6 female patients had a median age of 3.4 years (range 2-56). Diagnoses included congenital ptosis (12 pateints, 92%) and traumatic ptosis (1, 8%). All patients had levator function of <4mm. Mean preoperative MRD-1 was 1mm (-4-2), while mean postoperative MRD-1 at 3 month follow-up was 4mm (2.5-5).Mean follow-up was 13 months (4-19), and mean MRD-1 at last follow-up was 3.5mm (2-5, Fig 1G-H).
This modified frontalis sling procedure allows for successful ptosis repair via a straightforward technique with a quick learning curve, superior cosmetic results, and reduced operating time under general anesthesia. Future prospective studies would be valuable in comparing this method to conventional techniques.
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