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G.J. Lelli, Jr., T.N. Garvin, C.C. Nelson, D.C. Musch, B.R. Frueh; Outcomes in Silicone Rod Frontalis Suspension Surgery for Blepharoptosis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3972.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy and safety of silicone rod frontalis suspension for blepharoptosis.
Records of consecutive patients treated with silicone rod frontalis suspension for blepharoptosis from January 1985 through January 2005 were reviewed. The records of 90 eyelids of 59 patients were culled for diagnosis, previous surgical history, patient and physician subjective impression of surgical result, pre– and post–operative margin–reflex–distance (MRD), lagophthalmos, corneal staining (modified Oxford scale) and frequency of adjustment or replacement of the sling.
Diagnoses included congenital ptosis (29 eyelids), ocular myasthenia gravis (13), chronic progressive external ophthalmoplegia (13), oculopharyngeal dystrophy (11), cranial nerve III palsy (9), benign essential blepharospasm with apraxia (7), traumatic ptosis (6) and neurofibromatosis I (2). Thirty (33%) of the patients had previous ptosis surgery prior to a silicone rod suspension procedure. Surgery resulted in a significant increase in MRD (+2.5 mm; p<0.0001). Subjective patient assessment of the surgical result was deemed ‘good’ in 39 (43%) eyelids, ‘acceptable’ in 30 (33%) and ‘poor’ in 21 (23%). Global physician impression of the surgical result was ‘good’ in 42 (47%) eyelids, ‘acceptable’ in 24 (27%) and ‘poor’ in 24 (27%). The patients’ assessment of their outcome related well to the physicians’ assessment (Kappa=0.62, 95% CI: 0.48–0.76; p<0.0001). Lagophthalmos increased significantly post–operatively (+0.56 mm, p<0.0001), but there was no significant change in corneal staining grade after surgery (p=0.20). Thirty–eight (42%) eyelids required adjustment or replacement of the silicone sling, most often for adjustment of lid height.
Silicone rod frontalis suspension surgery is safe and effectively increases the MRD in blepharoptosis patients with minimal or no levator function. Patient and physician satisfaction correlate well. As expected, we note a relatively high proportion of patients who required adjustment or replacement of the slings. Silicone rod suspension surgery is chosen in these challenging ptosis cases for the ease with which these adjustments can be made.
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