Recurrence ptosis after frontalis suspension: Evaluation of associated factors*

Abstract

Background : Congenital blepharoptosis is a common eyelid problem. The treatment mostly used is frontalis suspension due to poor development of levator muscle. Frontalis suspension can be achieved in many ways such as autogenous fascia lata suspension, frontalis muscle transfer, synthetic material suspension including suture materials. Recurrence can be anticipated anyway in all procedures. Frontalis suspension using suture materials has been done for a long time in King Chulalongkorn Memorial Hospital since most patients were too young to use autogenous fascia lata. We would like to evaluate the recurrence rate and associated factors that influence the outcome.

Objective : To study recurrence rate of frontalis suspension procedure and associated factors that influence the outcome.

Design : Descriptive study

Setting : Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital

Material and Method : Definition of recurrent blepharoptosis, surgical failure, recurrent time were denoted. Twenty-three patients diagnosed with congenital blepharoptosis corrected by primary frontalis suspension using nylon suture material at King Chulalongkorn Memorial Hospital during January 2004 and December 2008 were reviewed. Data collected from surgical records, and variable factors were assessed.

Results : Twenty-three eligible patients were recruited into the study. Twelve out of 23 cases had recurrence (52.2%). The age group have association with recurrence (r = 0.3), p = 0.032, [95% CI, 0.006 - 0.802]. The age group < 2 years old seemed to have higher recurrence rate in contrast to the age group > 2 years old (68.8% vs 31.2%). Overall median time to recurrence was 27.5 months (SD 15.1), [95%CI, 0-57.0]. There was no statistically significant difference of recurrence rate among patients’ age group, gender, laterality and preoperative margin-reflex distance1 (MRD1).

Conclusion : Suture frontalis suspension had high recurrence rate with overall median survival time at 27.5 months. However, with nearly 2.5-year-survival, it might benefit very young children who need surgical correction but in whom autogenous fascia lata suspension could not be done. The age group was the only associated factor that influenced the outcome in the study.