# A Retrospective Analysis of the Efficacy of Silicone Sling in the Management of Severe Congenital Ptosis

## TL;DR

This study shows that silicone sling surgery effectively corrects severe congenital ptosis with minimal complications over a three-year period.

## Contribution

The study provides long-term efficacy data for silicone sling surgery in managing severe congenital ptosis.

## Key findings

- Silicone sling surgery achieved statistically significant improvement in MRD1 values at all follow-up intervals.
- Lid height asymmetry was significantly reduced post-surgery and remained stable over three years.
- 70.37% of patients had satisfactory correction, with complications being rare and mostly minor.

## Abstract

Introduction: Frontalis sling surgery is indicated in severe ptosis with poor levator action. A number of new sling materials are available, including silicone sling. The efficacy of sling surgery with silicone sling was analyzed.

Method: A retrospective study was conducted where records of patients who underwent frontalis sling surgery using silicone slings between July 2014 and June 2016 in a single center were analyzed. Patients had a follow-up of at least three years. The amount of correction achieved and complications, if any, were noted. Mean preoperative Marginal Reflex Distance 1 (MRD1) and mean postoperative MRD1 values were compared at six months, one year, and three years using a paired "t" test. Lid height asymmetry (LHA) was also measured preoperatively and compared with the postoperative values at six months, one year, and three years after surgery using the paired "t" test.

Results: About 27 patients underwent this procedure. Bilateral sling surgery was performed in all patients. Seventeen patients had severe simple congenital ptosis, three had monocular elevation deficit (MED), six had Marcus Gunn phenomenon (MGP) with ptosis, and one patient had blepharophimosis epicanthus syndrome (BPES). MRD1 was measured preoperatively to be 0.37 ± 1.72 mm. Follow-up MRD1 was measured at six months, one year, and three years postoperatively and was found to be 4.46 ± 1.28, 4.26 ± 1.46, and 3.79 ± 1.72 mm, respectively. Mean preoperative MRD1 and mean postoperative MRD1 values were compared at six months, one year, and three years using a paired "t" test and were found to be statistically significant (p < 0.001) at all follow-ups. Lid height asymmetry (LHA) was measured at 1.74 ± 3.96 mm preoperatively. Postoperatively, LHA was measured at six months, one year, and three years and was found to be 0.44 ± 1.18, 0.59 ± 1.3, and 0.89 ± 1.60 mm, respectively. On comparing mean preoperative LHA and mean postoperative LHA values at six months (p = 0.0006), one year (p = 0.0023), and three years (p = 0.0253) using a paired "t" test, the difference was found to be statistically significant at all follow-up visits.

At the end of the three-year follow-up, good correction was seen in 48.15% (13/27) of the cases, fair correction was seen in 29.62% (8/27) of the cases, and poor in 22.22% (6/27) of the cases.

A satisfactory correction was seen in 19 patients (70.37%). Complications seen were under-correction in one eye, lid notch in one eye, tube exposure in two eyes, suture granuloma in one eye, and late recurrence of ptosis in four eyes.

Conclusion: Silicone sling surgery is an effective surgery with few complications and a stable outcome even after three years of follow-up.