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K. Richani, M. Belyayev, D. Schlachter, E. Black; Long-Term Outcome of Frontalis Suspension Surgery Using Expanded Tetrafluoroethylene in Patients With Congenital Blepharoptosis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1470.
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Congenital blepharoptosis is generally treated by frontalis suspension surgery to clear the visual axis and decrease the risk of amblyopia in children. Different materials have been used to suspend the upper eyelid to the frontalis muscle including autologus fascia lata, autogenous palmaris longus, expanded polytetrafluoroethylene (ePTFE) and silicone rods. The objective of this study is to assess the long-term functional outcome of ePTFE suspensory material in the management of ptosis with poor levator function.
This retrospective study was performed by medical record analysis of patients who underwent unilateral or bilateral frontalis suspension surgery using ePTFE as suspensory material for correction of congenital blepharoptosis between 2001-2009. Ptosis etiology, gender, race, age at the time of surgery, initial and final lid margin position, levator muscle function, Bell’s phenomenon, success rate of correction, ptosis recurrence, follow-up time and complications such as granuloma formation, infection, and exposure keratopathy were recorded.
The study included 39 eyelids of 30 patients (20 males and 10 females) with ptosis. The mean age of surgery was 6.4 years old (0.6-16 years). Thirty percent of the patients had bilateral ptosis and 70% had unilateral ptosis. Overall, 89.7% of cases achieved a good postoperative eyelid position. The mean length of follow-up was 14.8 months (1-97 months). Twenty-three percent of patients developed granuloma with a mean interval to granuloma formation of 5 months. Interestingly, of the patients who developed granuloma, two thirds were African-Americans. Two out of the 39 cases developed infection. No cases were complicated by exposure keratopathy. Good eyelid position was reported in 94.1% of cases (16/17) with >12 months follow-up (mean 28 months, range 12-97 months).
Frontalis suspension surgery is the standard treatment in patients with congenital ptosis with poor levator function and ePTFE sling appears to be a safe and effective treatment for congenital blepharoptosis requiring frontalis sling surgery. Ptosis recurrence rate appears to be lower than other suspensory materials but the overall complication rates are similar. This study supports the continued use of ePFTE for frontalis suspension in this population.
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