Efficacy of Silicone Sling and Polypropylene (prolene) in Correction of Congenital Blepharoptosis by Frontalis Suspension

Abstract

Aims & Objective: To compare the cosmetic and functional results of frontalis suspension in congenital blepharoptosis using Silicone sling versus polypropylene. Materials and Methods: A retrospective study, that was conducted at tertiary care hospital from 1st January 2018 to December 2021, thirty two patients with age ranging from 5-50 years, with congenital ptosis having levator function of 4 mm or less were randomly divided into two groups: Group I (which included 16 patients who underwent frontalis brow suspension using silicon rod) and Group II (which consisted of 16 patients who underwent frontalis brow suspension using prolene). After proper pre-operative assessment frontalis brow suspension was performed under general / local anaesthesia. Post-operative cosmetic results, recurrence rates and associated complications were compared between these 2 groups. Final results were taken to be those at 1 month, 6 months' post-operative. Results: The mean age of the silicone group was 26.4 +/- 18.6 years while it was 26.6 +/- 21.4 years for the prolenegroup. There was a male predominant distribution in both groups (9:1 silicone, 7:3 prolene ). The mean late postoperative margin reflex distance (MRD) and palpebral fissure height (PFH) for silicone group was1.76 +/- 1.02, 9.45 +/- 2.34 while for the prolene group was0.65 +/- 0.54 , 6.56 +/- 2.74 respectively . Patients in silicone group had significantly higher PFHs (P<0.0001) and ( P< 0.005) as well as MRDs (P<0.0007) and (P< 0.054) at 6 month and 1 months postoperatively compared to those in prolene group Good cosmetic success graded by lid contour, symmetry, and crease in the silicone group was recorded in 81.25% (13/16), 56.25% (9/16), and 68.75% (11/16) of patients, respectively.In the prolene group, 56.25% (9/16) of patients experienced good outcomes in both contour and symmetry. However, 43.75% (7/16) of this group had good crease outcomes.Frontalis brow suspension showed significantly good cosmetic and functional results using silicone tube (93%) as compared to prolene (69%). Conclusion: The established treatment for ptosis with poor levator function is frontalis sling suspension surgery. The upper ptotic lid is attached to the frontalis muscle and the lid is elevated actively on elevating brow. The use of silicone rod in tarsofrontalis sling surgery for congenital ptosis repair is a safe and effective surgery, with few complications and easy removal and adjustment.