Fascia lata versus Silicone sling frontalis suspension for correction of congenital blepharoptosis

Abstract

Background: The ideal surgical treatment and age of intervention were controversial in the management of congenital ptosis, however congenital ptosis should be corrected in the early years of childhood, and amblyopia treatment commenced as soon as the diagnosis is established. Aims & Objective: To compare the cosmetic and functional results of frontalis suspension in congenital blepharoptosis using Fascia lata versus Silicone sling. Materials and Methods: In a prospective randomized study, that was conducted at Government Medical College, Srinagar -India from 1st January 2010 to 1st March 2012, thirty patients with age ranging from 5-55 years, with congenital ptosis having levator function of 4 mm or less were randomly divided into two groups: Group I (which included 15 patients who underwent frontalis brow suspension using fascia lata) and Group II (which consisted of 15 patients who underwent frontalis brow suspension using silicone sling). After proper pre-operative assessment Frontalis brow suspension was performed under general / local anaesthesia. Post-operative Cosmetic results, recurrence rates and associated complications were compared between these 2 groups. Final results were taken to be those at 3 months post-operative. Results: All patients had severe ptosis with average preoperative margin to reflex distance (MRD) of – 0.78 ± 1.23 mm. All eyelid in unilateral cases and worst eye in bilateral cases had poor levator function averaging 3.45 ± 0.55 mm and average levator function in better eyelid of bilateral cases was 4 ± 0.39 mm. Postoperatively in Group I, 14 (93%) out of 15 had satisfactory results based on MRD, among which, 12 (80%) patients showed good improvement in MRD (> 3 mm) and 2(13%) patients had moderate improvement in MRD (> 2 mm 3 mm). The remaining 4 (27%) of 15 patients showed poor MRD (< 1.5mm). Post-operative complications in Group II were as follows: 4 (26%) out of 15 patients showed under correction of ptosis, 1 (7%) patient had recurrence of ptosis due to slippage of silicone tube,1 (7%) patient had granuloma formation,1 (7%) patient had exposure of silicone sling after four postoperative weeks. Average post-operative MRD with brow up was 3.55 ± 0.73 mm in group I and 2.95 ± 0.17 mm in group II at 3 months after surgery. Conclusion: The established treatment for ptosis with poor levator function is frontalis sling suspension surgery. The upper ptotic lid is attached to the frontalis muscle and the lid is elevated actively on elevating brow. Treatment of severe congenital ptosis with frontalis brow suspension showed significantly good cosmetic and functional results using fascia lata (93%) as compared to silicone tube (73%). Larger prospective controlled trials are r