Abstract
Purpose :
To report the results and complications of frontalis suspension surgery using expanded polytetrafluoroethylene (ePTFE) for poor levator function blepharoptosis over a 2-year period.
Methods :
Retrospective chart review of all frontalis suspension surgeries performed by a single surgeon over 2-years. All procedures were performed using ePTFE of 2 or 3 mm width (Ptose-Up, FCI Ophthalmics). Surgeries were performed through an eyelid crease incision with a single pentagonal design involving suture fixation of material to the tarsal plate. The material was then tied in a square knot and buried just above the brow. Postoperative success was defined as upper margin reflex distance (MRD1) of 2.5 mm or more, a cosmetically acceptable eyelid contour, and lagophthalmos 1 mm or less. Complications included material breakage, granuloma formation, unacceptable contour, lagophthalmos and ptosis recurrence.
Results :
22 frontalis suspension surgeries were performed in 15 patients (14 children and 1 adult) from July 2013 to June 2015. The etiology of ptosis was congenital in 13 patients, third nerve palsy in 1 patient, and traumatic ptosis in 1 patient. Mean age of the children was 3 years (Range 1-5 years). Mean follow up time was 5 months. 13 procedures (60%) had successful results that did not require reoperation. In 2 procedures (9%) the ePTFE broke intraoperatively and the procedure was repeated immediately. In 5 procedures (23%) the ePTFE broke in the postoperative period (range postoperative day 1 to 44), which was confirmed during reoperation. 1 patient (4%) developed a brow granuloma and abscess that required surgical removal of the material. 1 eyelid (4%) had undesirable contour requiring reoperation.
Conclusions :
ePTFU has been reported as an excellent material for frontalis suspension surgery with a low rate of ptosis recurrence and complications. Our data concurs with other studies in terms of achieving excellent eyelid height and contour with this material. However, in our cohort there was a high incidence of material breakage in the early postoperative period, as well as two cases of intraoperative breakage. This is an important complication to be aware of when using ePTFE. Factors such as material width and thickness, surgical technique, handling of the material, and postoperative care may all play a role.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.