LONG-TERM RESULTS OF FRONTALIS SUSPENSION USING IRRADIATED, BANKED FASCIA LATA

This study was undertaken to study the long-term rate of recurrence of ptosis and other postoperative complications after frontalis suspensi on using banked irradiated fascia lata. One hundred thirty-two lids of 72 patients underwent frontalis suspension between 1980 and 1989. The preoperative diagnoses included severe congenital ptosis (83%), bleph arophimosis (10%), third nerve palsy (4%), and chronic progressive ext ernal ophthalmoplegia (3%). The age at the time of surgery ranged from 5 months to 19 years, with an average of 3 years and 5 months. In 46 patients (64%), surgery was done before age 3 years. The follow-up tim e ranged from 6 to 15 years, with a mean and median of 10 years. Good to excellent lid height was achieved immediately after surgery in all but three patients. Recurrence of ptosis occurred in 20 cases (28%), a nd 28 lids (21%). The time to reoperation ranged from 1 to 7 years, wi th an average of 3 years. Sixteen patients (80%) with recurrence were younger than 3 years of age. Reaction to donor fascia lata occurred in only two patients (3%). Only one patient suffered from excessive expo sure keratopathy and required revision of the sling. Banked fascia lat a is easy to use and should be considered as an alternative suspensory material in children younger than 3 years of age with congenital ptos is. The long-term reoperation rate in this cohort of patients was high er than the 5% rate reported for autogenous fascia, but lower than tha t previously reported for banked fascia lata (50% at 8 years).