Unilateral ptosis correction with mersilene mesh frontalis sling in infants: thirteen-year follow-up report

Abstract

Purpose To assess surgical, visual, refractive, and aesthetic outcomes 13 years after mersilene mesh frontalis sling (MMFS) operation for severe unilateral congenital ptosis performed in 10 infants before 1 year of age. Methods Longitudinal follow-up of an interventional case series by structured ocular examinations, external photographs, and questionnaire-based interviews.Results Mean age at surgery was 6.9±2.7 months. After a mean follow-up of 13.0±0.6 years, one patient (10%) had recurrent ptosis with the upper lid 2 mm below the superior limbus at 3 months postoperatively. Best-corrected visual acuities were within two Snellen lines between the two eyes in all patients. Astigmatic errors were 1.20±1.00 D and 1.10±1.70 D between operated and unoperated eyes. Four patients had 2 mm lid lag on down-gaze and one of them had 2 mm lagophthalmos. Mean satisfaction scores (scale of 1 to 100) for lid position, cosmesis, function, and to the procedure were 83.3 ± 11.8, 77.0±22.9, 89.4±5.5, and 86.8±6.3, respectively. No case of overcorrection, sling extrusion, stitch granuloma, or exposure keratopathy was noted. Conclusions In view of the low recurrence rate (10%) and absence of serious complication or need for revision after 13 years, the use of MMFS seems effective and feasible in infants less than 1 year old. Achieving compatible long-term stability, satisfactory aesthetic, and visual outcomes, MMFS may offer an alternative to delaying operations for autogenous fascia lata harvesting in infants requiring early ptosis correction.

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

“…At the end of the process, 48 publications meeting the eligibility criteria were selected for review ( Fig 1 ). The number of studies included for Fascia Lata were 19 [ 10 – 28 ], for Mersilene 12 [ 29 , 30 , 22 , 31 , 32 , 25 , 33 – 38 ], for PTFE 5 [ 39 – 41 , 26 , 42 ] and for Silicon 17 [ 43 – 52 , 13 , 53 , 54 , 20 , 55 – 57 ].…”

“…Table 1 shows characteristics of the studies included [ 15 , 29 , 30 , 32 , 34 – 36 , 38 – 41 , 51 ]. The time range of the selected studies was 1990[ 38 ]-2015[ 35 ].…”

Analysis of visual outcomes and complications following levator resection for unilateral congenital blepharoptosis without strabismus

“…Some surgeons advocate very early correction for patients with unilateral congenital ptosis to prevent amblyopia. [22,23] Others prefer delaying ptosis surgery until the child is 4 years old. [24] Because of these factors, the aim of this study was to retrospectively evaluate the visual outcomes and complications of levator resection in patients with unilateral congenital blepharoptosis and determine the optimal time for surgical correction of unilateral congenital blepharoptosis.…”

“…[3] As a result, several case series of severe congenital blepharoptosis adopted early correction in infants to prevent occlusion amblyopia and developing strabismus. [7,22,23] Conversely, some authors advocated congenital blepharoptosis need not be corrected early in life because stimulus deprivation due to ptosis presents the least common cause of amblyopia. [2,32,40] Some studies even found postoperative increased astigmatism in eyes that underwent levator resection for unilateral congenital blepharoptosis.…”

Comparison of Outcomes of Suprabrow Single-Stab and 3-Stab Incision Frontalis Sling Surgery

“…2,3 Infection and late recurrence are the 2 disadvantages of using exogenous material for frontalis sling surgery, 4 and some surgeons prefer using autogenous tissue instead. However, some important elements such as lid contour and/or any lid peaking was not included as an outcome measure.…”