FEB 26, 2009
Autologous fascia lata is still considered the gold standard of frontalis sling material. However, the authors of this nonrandomized, retrospective study reported better cosmetic results and a lower recurrence rate three years after frontalis sling surgery for congenital ptosis using silicone rod compared with preserved fascia lata (PFL).
They reviewed the medical records of all patients who underwent frontalis sling surgery for congenital ptosis at one hospital with one surgeon over a five-year period. PFL was used for the frontalis sling for the first three years, during which 63 patients meeting the study inclusion criteria were treated, and silicone rod was used during the remaining two years in 60 included patients. Subjects were treated for unilateral or bilateral congenital ptosis with poor levator function of less than 4 mm. Cosmetic results were judged good, fair or poor based on habitual upper lid height and symmetry. Recurrence was defined as conversion from a good or fair result to a poor one.
After three and six months, cosmetic results were similar for the two treatment groups for both unilateral and bilateral cases, which were compared separately. But the results with silicone rod were significantly better than with PFL for unilateral and bilateral patients one, two and three years after surgery. Recurrence rates with silicone rod were 29.2 percent for bilateral cases and 11.1 percent for unilateral cases after three years, compared with 63.2 percent and 41.4 percent, respectively, for PFL patients. The authors claimed that suturing the rod directly at the tarsus decreased the recurrence rate.
Primarily an examination of sling material, this study did not consider other aspects of frontalis surgery, such as bilateral versus unilateral, pentagon versus double trapezoid and stab incision versus direct tarsal suturing.