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Michael R Chua, Danielle M Lo, James A Katowitz, William R Katowitz; Long Term Outcomes of Frontalis Suspension Surgery Using Autogenous Fascia Lata Slings in Children with Congenital Ptosis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):88.
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© ARVO (1962-2015); The Authors (2016-present)
Frontalis suspension surgery is a common procedure for the treatment of congenital ptosis. Autogenous fascia lata is the preferred sling material for ptosis repair because of its low risk of rejection and excellent tensile strength. There have been few studies investigating the long-term outcomes of frontalis suspension surgery using autogenous fascia lata. We reviewed the functional and cosmetic outcomes of children receiving frontalis suspension surgery using autogenous fascia lata slings.
Retrospective cohort study of children 0 to 18 years of age with a diagnosis of congenital ptosis who received frontalis suspension surgery using autogenous fascia lata slings at The Children’s Hospital of Philadelphia from 2009 to 2017. Preoperative and postoperative evaluations were reviewed to determine the change in marginal reflex distance-1 (MRD1), complication rates, and rates of reoperation. A paired t-test was used to compare pre-operative and post-operative MRD1. Cosmetic outcomes were assessed by lid height, lid crease, and lid contour using clinical photographs.
A total of 98 subjects were included in the study: 40 (40.8%) female, 58 (59.2%) male. Mean age at surgery was 7.3 years (SD 3.9). Mean post-operative follow-up was 2.1 years (SD 2.0). 73 (74.5%) children received unilateral autogenous fascia lata sling surgery, while 25 (25.5%) children received bilateral surgery, for a total of 123 eyes. 73 (74.5%) children had previous ptosis surgery, such as Muller muscle resection or frontalis suspension surgery using silastic slings. The mean increase in MRD1 of subjects after surgery was 1.4mm (p < .0001). 32 (32.7%) subjects experienced complications, most commonly lagophthalmos (13, 13.3%), entropion (8, 8.2%), exposure keratopathy (6, 6.1%), and eyelid retraction (3, 3.1%). 15 (15.3%) subjects required reoperation. The most common indications for reoperation were entropion repair (8, 8.2%) and recurrent ptosis (5, 5.1%). Mean post-operative time to reoperation was 2.4 years (SD 2.0). The majority of subjects (91, 92.9%) had improved cosmetic outcomes after surgery.
Frontalis suspension surgery with autogenous fascia lata slings is a safe and effective treatment for children with congenital ptosis. The most common complications of the procedure were lagophthalmos, entropion, exposure keratopathy, and eyelid retraction.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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