Frontal suspension for congenital ptosis using an expanded polytetrafluoroethylene (Gore-Tex®) sheet: one-year follow-up

Abstract

BackgroundThe frontalis suspension technique is the surgical method of choice in patients with ptosis and a levator function of 4 mm or less. Several types of materials have been used, including Gore-Tex®, which has been used successfully as a frontalis sling material since 1986. Recently, a Gore-Tex sheet (wider than a sling or strip) suspension was reported. This paper reports the results of 27 eyes from 20 patients with congenital ptosis treated using the frontalis suspension technique with the newly developed Gore-Tex Most Versatile Patch (MVP) sheet.MethodsAll patients underwent surgery between April 2007 and September 2011 and were followed up for at least one year. The average follow-up duration was 18 months, with a range of 12–36 months. The average patient age was 45 (5–85) years, and the group included 11 males and nine females. Thirteen cases demonstrated ptosis in one eye, and seven cases involved both eyes. The patients were divided by age into a younger group and an older group. All ptosis procedures were performed using the Gore-Tex MVP sheet. The implant was normally 7 mm wide for adults and 5 mm wide for children. The implantation method was the same as that used for the sheet shape fascia.ResultsIn all patients, satisfactory functional results were observed at the 6-month follow-up examination. Eyelid opening heights were also obtained. The average marginal reflex distance (MRD) was −0.5 mm preoperatively, which improved to +1.9 mm after surgery. After one year, average MRD was +1.6 mm. MRD attenuation was more frequent in the younger group. There were no cases requiring redo surgery and only one case of exposure.

Clinical trial comparing autogenous fascia lata sling and Gore-Tex suspension in bilateral congenital ptosis

“…Ectropion was seen more in GTS, which is more malleable and more liable for overtraction, leading to more exposure with eversion of the lid. This matches with Nakaucia et al’s 18 findings. Ectropion can be managed after surgery with traction exercises.…”

“…This is similar to other studies, 8 as fascia lata can integrate with tissue and potentiate the frontalis muscle action to elevate the eyelid. 17 Nevertheless, Nakaucia et al 18 found that the GTS has satisfactory functional results as it produces more stable traction.…”

“…This matches with reports from other studies. 6 However, Nakaucia et al 18 concluded that if the GTS sheet is sterilized by ethylene oxide gas preoperatively, no cases of infection occurred.…”

Frontalis Suspension Using Autogenous Fascia Lata versus Gore-tex Sheet for Treatment of Congenital Ptosis with Poor Levator Function

“…There was no need for redo surgery in any of these cases in one year follow up period of the study [22]. As well, they had one case of exposure of the Gore-Tex sheet in a 71-year-old man who experienced more bleeding than the other patients, and wound recovery was slow [22].…”

Pediatric Blepharoptosis

“…8,19,20 Cable suture slings, such as Prolene or nylon, are particularly susceptible to recurrence; therefore, they are primarily indicated as temporary treatment to prevent amblyopia in severe ptosis. [20][21][22] Expanded polytetrafluoroethylene (ePTFE) is a synthetic porous fluoropolymer with a low recurrence rate 23,24 and an infection rate between 7% and 45.5%. 20,23 Silicone provides the benefits of easy reversibility and increased elasticity, which decreases the risk of lagophthalmos (►Fig.…”