Comparison Of Frontalis Sling With Or Without Tarsal Fixation Sutures For Severe Ptosis With Poor Levator Function

Abstract

Objective: To compare the outcomes of frontalis sling with tarsal fixation or without tarsal fixation suture in patients of severe ptosis with poor levator function.

Methods: This QUASI-experimental study was conducted at the College of Ophthalmology & Allied Vision Sciences/King Edward Medical Study after obtaining ethical approval vide no 2162/22.  Ten Patients above 10 years of age and having levator muscle function of less than 4mm were selected by probability consecutive sampling. Those patients who were diagnosed with Blepharophimosis, Marcus Gun phenomenon, CN III palsy and other lid or facial deformities were excluded. Patients were equally divided into two groups A and B. Group A patients underwent fascia lata sling with tarsal fixation while Group B patients underwent simple fascia lata sling without tarsal fixation. Postoperatively (1 week) surgical success including marginal reflex distance (MRD) and complications including slippage of the sling, exposure keratopathy, recurrence and lid margin deformity were evaluated. Paired t-test and Independent sample t-test were applied to check for statistical significance. 

Results: Eight out of ten patients had bilateral ptosis with poor levator muscle function while the other two patients had unilateral ptosis. Changes in the marginal reflex distance and palpebral fissure height after surgery were statistically significant. Both marginal reflex distance and palpebral fissure height were statistically better in group A as compared to group B (0.001 & 0.003) respectively.

Conclusion: Cosmetic results are better when a fascia lata sling is done with tarsal fixation sutures.

Keywords: Ptosis, Fascia lata, Patients