J Korean Ophthalmol Soc.  2008 Apr;49(4):548-554. 10.3341/jkos.2008.49.4.548.

Frontalis Suspension Using a Silicone Rod in Blepharoptosis Patients with Poor Ocular Motility

• Choi YJ
• Kim YD

• KMID: 2211483
• DOI: http://doi.org/10.3341/jkos.2008.49.4.548

Abstract

PURPOSE: To determine the efficacy of frontalis sling operation with silicone rods in patients with compromised corneal protective mechanisms.
METHODS
The authors retrospectively studied 6 consecutive patients (7 eyelids) with severe blepharoptosis with poor ocular motility who had undergone frontalis sling operations using silicone rods.
RESULTS
Preoperative diagnoses included third nerve palsy in 4 patients, double elevator palsy in 1 patient, and suspicious oculopharyngeal muscular dystrophy in 1 patient. With a mean follow up of 27.7 months, a good final lid height was achieved in all 7 eyelids. Mild exposure keratopathy occurred postoperatively in 3 patients. During the follow-up period, no other significant complications, such as extrusion of the sling or infection, occurred.
CONCLUSIONS
Silicone rods are effective and safe materials for use in frontalis suspension in treating blepharoptosis in patients with inadequate or absent Bell's phenomenon, resulting in poor eye protective mechanisms associated with an increased incidence of corneal exposure.

Keyword

Absent Bell's phenomenon; Blepharoptosis; Frontalis sling; Silicone rod

MeSH Terms

Blepharoptosis
Elevators and Escalators
Eye
Eyelids
Follow-Up Studies
Humans
Incidence
Muscular Dystrophy, Oculopharyngeal
Oculomotor Nerve Diseases
Paralysis
Retrospective Studies
Silicones
Silicones

Figure

• 

  Figure 1. (A) Preoperative photography of a patient with double elevator palsy demonstrates visually significant left upper lid ptosis. Note the limitation of upgaze (B), lateral gaze (C) and down gaze (D). (E) Forty‐ two months after sling operation with silicone rod. (F) Good lid closure and absence of significant lagophthalmos.

• 

  Figure 2. (A) Preoperative photography of a 32‐ year‐ old woman with third nerve palsy, demonstrates visually significant left upper lid ptosis. Note the limited up gaze (B) and down gaze (D). (E) Same patient 12 months after sling operation with silicone rod (E). The left upper eyelid position was above the pupil and cosmetically acceptable. (F) Demonstrating good lid closure and absence of significant lagophthalmos.

Reference

References

1. Beard C. The surgical treatment of blepharoptosis: a quantitative approach. Trans Am Ophthalmol Soc. 1966; 64:401–87.

2. Beard C. Ptosis. 3rd ed.St. Louis: CV Mosby;1981. p. 41.

3. Crawford JS. Repair of ptosis using frontalis muscle and fascia lata. Trans Am Acad Ophthalmol Otolaryngol. 1956; 60:672–8.

4. Yi KY, Chi YH, Woo KI, Kim YD. Frontalis sling operation using preserved fascia lata. J Korean Ophthalmol, Soc. 1997; 38:2084–90.

5. Crawford JS. Repair of ptosis using frontalis muscle and fascia lata: a 20 year review. Ophthalmic Surg. 1977; 8:31–40.

6. Katowitz JA. Frontalis suspension in congenital ptosis using a polyfilament, cable‐ type suture. Arch Ophthalmol. 1979; 97:1659–63.

7. Tillett CW, Tillett GM. Silicone sling in the correction of ptosis. Am J Ophthalmol. 1966; 62:521–3.

8. Leone CR Jr, Rylander G. A modified silicone frontalis sling for the correction of blepharoptosis. Am J Ophthalmol. 1978; 85:802–5.

9. Goldberger S, Conn H, Lemor M. Double rhomboid silicone rod frontalis suspension. Ophthal Plast Reconstr Surg. 1991; 7:48–53.

10. Zweep HP, Spauwen PH. Evaluation of expanded polytetrafluoroethylene (e-PTFE) and autogenous fascia lata in frontalis suspension. A comparative clinical study. Acta Chir Plast. 1992; 34:129–37.

11. Steinkogler FJ, Kuchar A, Huber E, Arocker‐ Mettinger E. Gore‐ Tex soft‐ tissue patch frontalis suspension technique in congenital ptosis and in blepharophimosis‐ ptosis syndrome. Plast Reconstr Surg. 1993; 92:1057–60.

12. Wagner RS, Mauriello JA Jr, Nelson LB, et al. Treatment of congenital ptosis with frontalis suspension: a comparison of suspensory materials. Ophthalmology. 1984; 91:245–8.

13. Kim J-Y, Kim YD. Frontalis suspension using autogenous fascia lata. J Korean Ophthalmol Soc. 2004; 45:1799–1805.

14. Bernardini FP, de Conciliis C, Devoto MH. Frontalis suspension sling using a silicone rod in patients affected by myogenic blepharoptosis. Orbit. 2002; 21:195–8.

15. Older JJ, Dunne PB. Silicone slings for the correction of ptosis associated with progressive external ophthalmoplegia. Ophthalmic Surg. 1984; 15:379–81.

16. Waller RR. Management of myogenic (myopathic) ptosis. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1975; 79:697–702.

17. Burnstine MA, Putterman AM. Upper blepharoplasty: a novel approach to improving progressive myopathic blepharoptosis. Ophthalmology. 1999; 106:2098–100.

18. Pak J, Shields M, Putterman AM. Superior tarsectomy augments super‐ maximum levator resection in correction of severe blepharoptosis with poor levator function. Ophthalmology. 2006; 113:1201–8.

19. Karesh JW. Multilevel full‐ thickness eyelid resection for the correction of severe acquired ptosis in the poorly functioning eyelid. Ophthalmic Surg. 1991; 22:399–405.

20. Holck DE, Dutton JJ, DeBacker C. Lower eyelid recession combined with ptosis surgery in patients with poor ocular motility. Ophthalmology. 1997; 104:92–5.

21. Shorr N, Christenbury JD, Goldberg RA. Management of ptosis in chronic progressive external ophthalmoplegia. Ophthal Plast Reconstr Surg. 1987; 3:141–5.

22. Demartelaere SL, Blaydon SM, Shore JW. Tarsal switch levator resection for the treatment of blepharoptosis in patients with poor eye protective mechanisms. Ophthalmology. 2006; 113:2357–63.

23. Putterman AM. Suture tarsorrhaphy system to control keratopathy after ptosis surgery. Ophthalmic Surg. 1980; 11:577–80.

24. Leone CR Jr, Shore JW, Van Gemert JV. Silicone rod frontalis sling for the correction of blepharoptosis. Ophthalmic Surg. 1981; 12:881–7.

25. Wong VA, Beckingsale PS, Oley CA, Sullivan TJ. Management of myogenic ptosis. Am J Ophthalmol. 2002; 109:1023–31.

26. Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology. 1996; 103:623–30.

27. Kim SD, Kang PS, Pae CH, Kim JD. Silicone tube frontalis sling for the correction of blepharospotis. J Korean Ophthalmol Soc. 2000; 41:2521–6.

28. Cho JH, Park JS, Lee JH. Frontalis suspension using silicone rod. J Korean Ophthalmol Soc. 2002; 43:343–8.