Effectiveness and safety of expanded polytetrafluoroethylene-assisted frontalis suspension for pediatric congenital ptosis

Abstract

Background Congenital ptosis is a common eye disease of children that easy cause amblyopia.Searching for an ideal frontalis suspension material is very important for the timely treatment of ptosis.Expanded polytetrafluoroethylene (e-PTFE), a new frontalis suspension material, has been widely applicated abroad to correct the congenital ptosis, but the clinical data of e-PTFE use in congenital ptosis is lack. Objective This study was to evaluate the efficacy and safety of e-PTFE patch as sling material in frontalis suspension surgery for congenital ptosis of children. Methods A prospective serial cases-observational study was conducted.Forty-five eyes of 36 children with congenital ptosis enrolled in Beijing Children's Hospital from July to August 2012 with the age of 2.8-6.0 years.All the children received e-PTFE-frontalis sling surgery after their custodians signed the informed consent.The margin-reflex distance (MRD) upper eyelids, width of palpebral fissure, linkage between the frontalis muscle and the upper eyelid, catamysis, upper eyelid late drop, appearance score, recurrence rate and postoperative complications were evaluated 1 day, 1 week, 1 month, 3 months, 6 months and 1 year, 1.5 years after surgery. Results The mean MRD was (1.8±1.2)mm and (2.8±0.8)mm before surgery and 1.5 years after surgery, respectively, showing a significant difference between them (t=4.651, P=0.000). The catamysis was (1.3±0.5)mm and (1.1±0.5)mm before surgery and 1.5 years after surgery, respectively, and there was not significant difference between them (t=1.897, P=0.061). The linkage between the frontalis muscle and the upper eyelid after surgery was 75%±20%, and e-PTFE achieved a satisfied stable ptosis correction and approving appearance.Ptosis recurrence was noticed in 1 case; The complications included low-correction in 1 eye of 1 patient, slight ceratitis in 1 eye of 1 patient, entropion in 1 eye of 1 patient, granuloma in 1 eye of 1 patient and subcutaneous nodule in 20 eyes of 16 patients, and these complications were cured by medication.Recurrence of ptosis was seen in 1 patient and was cured by reoperation. Conclusions E-PTFE is an effective and safe frontalis sling material in frontalis sling surgery for congenital ptosis of younger children.This surgery is ideal for the improvement of both upper eyelid function and appearance. Key words: Blepharoptosis/congenital; Blepharoptosis/surgery; Blepharoplasty/methods; Prosthesis implantation; Polytetrafluoroethylene, expand; Child; Treatment outcome; Frontalis suspension