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E. S. Hong, E. Watterberg, L. Morrison, K. D. Carter, R. C. Allen; Predictors for Lid Crease Formation After Frontalis Suspension Surgery for Myogenic Ptosis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1471.
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To determine which pre-operative and intra-operative factors influence formation of a lid crease after frontalis suspension surgery in patients with myogenic ptosis.
This study was a non-randomized, retrospective, comparative case series. Patients were identified from the practice of a single individual (RCA). The study was in compliance with the Declaration of Helsinki. The following data were obtained: patient age; diagnosis; pre-operative margin reflex distance (MRD); palpebral fissure height (PF); and levator function (LF); surgical procedure details; and post-operative MRD. Post-operative photographs were reviewed and the lid creases were graded by two reviewers (RCA and KDC) as poor, fair, or good.
41patients (81 eyelids) were identified who underwent frontalis suspension surgery using a silicone sling by a single surgeon. Tarsal fixation of the sling and retro-septal placement of the sling was performed in all surgeries. Mean age at the time of surgery was 62.7 years. 39 patients (95%) had a diagnosis of oculopharyngeal muscular dystrophy (OPMD). Pre-operative mean MRD, PF, and LF were 0.20 mm, 5.1 mm, and 10.9 mm, respectively. Mean follow up was 13 months. Post-operative mean MRD was 2.3 mm. The following factors correlated positively with a good lid crease: levator function, conservative concurrent blepharoplasty, preservation of preaponeurotic fat, and incorporation of the levator aponeurosis into the skin closure.
The following factors appear to influence favorably towards the formation of a lid crease in patients with myogenic ptosis who underwent frontalis suspension with a silicone frontalis sling: pre-operative levator function, preservation of skin above the lid crease, preservation of pre-aponeurotic fat, and incorporation of the levator aponeurosis into the skin incision/crease closure.
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