Surgical Treatment of Severe Degree of Ptosis of the Upper Eyelid Using a Fronto-tarsal Sling of Biocompatible PVC

Česká verze

Authors: H. Hejsek; V. Veliká; A. Stepanov; P. Rozsíval
Authors place of work: Oční klinika Fakultní nemocnice, Hradec Králové, přednosta prof. MUDr. Pavel Rozsíval, CSc., FEBO
Published in the journal: Čes. a slov. Oftal., 70, 2014, No. 3, p. 103-108
Category: Původní práce

Summary

Purpose:
ptosis is anomalous drop of the upper eyelid. Depending on the cause of the state and especially according to the results of clinical findings (dominated significance of elevation of the upper eyelid) we can be perform various surgical procedures. Operation under Fasanella-Servat is suitable for the easiest cases -⁠ function of the upper eye-lid levator muscle (levator) is at least 10 mm and a maximum of 2 mm ptosis. Aponeurosis advancement has good results in all types of involutional origin. Eyelid levator resection is performed when the levator function is better than 5 mm. Eye-lid sling to brow lift mechanism is designed for the toughest conditions, when the levator function is worse than 4 mm. The authors present the results of surgery for ptosis with biocompatible PVC tube fronto-tarsal sling.

Methods:
case-reports of 4 eyes in 3 adult patients were prospectively monitored. It was a one man and two women with different etiologies of ptosis. The principle of operation is suspension the upper eyelid to eyebrow-levators using PVC tubes in the subcutaneous tissue. Monitored parameters were: best corrected visual acuity, clinical finding of the front segment (with an emphasis on lagophthalmos in the postoperative period), eye-fissure height and levator function in millimeters (mm).

Results:
there was the most severe degree of ptosis in all cases. In terms of functional and cosmetic effect treatment were surgeries successful in all patients. One half of the cases (2 of 4 eyes) had transient postoperative lagophtalmos, which in one case was solved with moisture chamber. None of exposure keratopathy developed. In one case, it was after 9 months after the operation, we had to extract one implant due to extruzion of the tube.

Conclusions:
The fronto-tarsal tubing with biocompatible PVC is effective and relatively safe technique in cases of severe degree of ptosis of the upper eyelid. The material appears to be well tolerated by the surrounding tissue.

Key words:
ptosis surgery, fronto-tarsal sling, biocompatible PVC

Zdroje

1. Beard, C.: Ptosis surgery past, present and future. Ophthalm Plast Reconstr Surg, 1985; 1 : 69–72.

2. Callahan, A.: Correction of unilateral bleharoptosis with bilateral eyelid suspension. Am J Ophthalmol, 1972; 74 : 321–326.

3. Carter, SR., Meecham,WJ., Seiff, SR.: Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology, 1996; 103 : 623-630.

4. Collin, JR., O´Donnell, BA.: Adjustable sutures in eyelid surgery for ptosis and lid retraction. Br Ophthalmol, 1994, 78 : 167–174.

5. Hintschich, CR., Zurcher, M., Collin, JR.: Mersilene mesh brow suspension: efficiency and complications. Br J Ophthalmol, 1995; 79 : 358–361.

6. Kanski et al.: Clinical Ophthalmolgy, Butterworth Heinemann, Madison, 2000, p. 32.

7. Kuchynka a kol.: Oční Lékařství, Grada a.s., Praha, 2007, s. 635, 655.

8. Kwon, KA., Shipley, RJ., Edirisinghe, M. et al.: Microstructure and mechanical properties of synthetic brow-suspension materiale. Materials Science and Engineering C, 2014; 35 : 220–230.

9. Leone Jr., CR., Shore, JW., Van Gemert, JV.: Silicone rod frontalis sling for the correction of blepharoptosis. Ophthal Surg, 1981; 12 : 881–887.

10. Mutlu, FM., Tuncer, K., Can, C.: extruzion and granuloma formation with mersilene mesh brow suspension. Ophthalmic Surg and Lasers, 1999; 30 : 47–51.