Suspensory Materials for Surgery of Blepharoptosis: A Systematic Review of Observational Studies

Abstract

BackgroundFrontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced.ObjectivesThe aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon.Data Source and MethodsFollowing the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus.ResultsThe search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications.ConclusionsAlthough most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results.

Surgical treatment of unilateral severe simple congenital ptosis

“…Frontalis suspension surgery has been considered as the most successful surgical option for correcting congenital ptosis with poor levator function of ≤4 mm. [ 10 11 12 13 14 ] This technique was described by Wright,[ 15 ] and further developed with the use of autogenous fascia lata as the standard suspension material by Crawford. [ 11 ] It allows the frontalis muscle to elevate the upper eyelid upward by creating a connection between the frontalis muscle and the upper tarsal plate.…”

Analysis of the causes of recurrence after frontalis suspension using silicone rods for congenital ptosis

“…Blepharoptosis is one of the most common oculoplastic disorders, and different surgical techniques have been described to correct it. Maximal/super-maximum levator resection, Whitnall’s sling, or check ligament suspension was introduced for severe ptosis with poor levator muscle function (LF) [ 1 – 4 ], however, frontalis suspension is a commonly used surgical method for patients with congenital ptosis and poor LF [ 5 – 7 ]. Many suspension materials are available, including autogenous or banked fascia lata and synthetic materials such as silicone rod, monofilament nylon, polyfilament nylon, expanded polytetrafluoroethylene (ePTFE), and polypropylene [ 7 – 11 ].…”

“…Maximal/super-maximum levator resection, Whitnall’s sling, or check ligament suspension was introduced for severe ptosis with poor levator muscle function (LF) [ 1 – 4 ], however, frontalis suspension is a commonly used surgical method for patients with congenital ptosis and poor LF [ 5 – 7 ]. Many suspension materials are available, including autogenous or banked fascia lata and synthetic materials such as silicone rod, monofilament nylon, polyfilament nylon, expanded polytetrafluoroethylene (ePTFE), and polypropylene [ 7 – 11 ]. Although autogenous fascia lata is considered the best suspension material due to its lower rates of recurrence and complications [ 6 , 7 , 10 – 12 ], and it remains an excellent choice for severe congenital ptosis [ 13 ], synthetic materials may be preferred in children younger than 3 years or for patients who do not want an additional harvesting operation.…”

“…Many suspension materials are available, including autogenous or banked fascia lata and synthetic materials such as silicone rod, monofilament nylon, polyfilament nylon, expanded polytetrafluoroethylene (ePTFE), and polypropylene [ 7 – 11 ]. Although autogenous fascia lata is considered the best suspension material due to its lower rates of recurrence and complications [ 6 , 7 , 10 – 12 ], and it remains an excellent choice for severe congenital ptosis [ 13 ], synthetic materials may be preferred in children younger than 3 years or for patients who do not want an additional harvesting operation. Meanwhile, some reports have indicated that autogenous fascia and alloplastic materials resulted in similar functional and cosmetic results in frontalis suspension surgery [ 8 , 9 ].…”

“…Meanwhile, some reports have indicated that autogenous fascia and alloplastic materials resulted in similar functional and cosmetic results in frontalis suspension surgery [ 8 , 9 ]. In addition, a recent review study suggested that PTFE is the material with lowest recurrence rates as well as good cosmetic and functional results [ 7 ].…”