Frontalis Sling Operation Using Silicone Rod Compared with Preserved Fascia Lata for Congenital Ptosis A Three-Year Follow-up Study

Abstract

Purpose: To evaluate the 3-year results of frontalis sling operation using a silicone rod compared with preserved fascia lata for congenital ptosis. Design: Retrospective, nonrandomized, comparative, interventional case series. Participants: One hundred twenty-three patients with congenital ptosis. Methods: The medical records of 123 patients who underwent a frontalis sling operation for congenital ptosis were retrospectively reviewed. Patients were divided into 2 groups according to the sling material used; a preserved fascia lata group (n = 63) and a silicone rod group (n = 60). Cosmetic results and recurrence rates were compared between these 2 groups. The cosmetic results of the frontalis sling operation were assessed as good, fair, or poor based on the habitual upper lid heights and symmetry, and bilateral cases and unilateral cases were compared separately. Recurrence was defined as the conversion of the cosmetic result from good or fair to poor category. Main Outcome Measures: Postoperative cosmetic results and recurrence rate. Results: At the 3- and 6-month follow-ups, the cosmetic results were not significantly different between the 2 groups (P = 0.17 and P = 0.25 for bilateral cases and P = 0.14 and P = 0.35 for unilateral cases, respectively, by Armitage's test of trend in proportions). However, the silicone rod group showed significantly better cosmetic results than the preserved fascia lata group at 1, 2, and 3 years after surgery in both bilateral and unilateral cases (all P < 0.05, by Armitage's test of trend in proportions). At 3 years after surgery, the recurrence rates were 29.2% (7/24 bilateral cases) and 11.1% (3/27 unilateral cases) for the silicone rod group, and 63.2% (12/19 bilateral cases) and 41.4% (12/29 unilateral cases) for the preserved fascia lata group. Conclusions: Given the limitations of this retrospective study, the frontalis sling operation using a silicone rod showed better cosmetic results and lower recurrence rate compared to the procedure using preserved fascia lata up to 3 years after surgery for congenital ptosis. However, only prospective randomized studies can give a more accurate conclusion in that regard. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2009; 116:123-129 (C) 2009 by the American Academy of Ophthalmology.