Effect of suturing the silicone rod to the tarsal plate and the suture material used on success of frontalis suspension surgery.

To evaluate the effect of suturing the silicone rod to the tarsal plate and the suture material used in suturing on surgical success of frontalis suspension for congenital ptosis. Eighty eyes of 56 consecutive patients who underwent frontalis suspension surgery using silicone rods for congenital ptosis between 2005 and 2011 were included in this retrospective study. The surgical results of eyes were compared, in which silicone had not been sutured to the tarsal plate (group 1), with those sutured with monofilament polypropylene suture (group 2), and those sutured with polybutylate-coated braided polyester suture (group 3). Surgical success indicated that the postoperative eyelid position was maintained within 1 mm of the normal eyelid position, that is, 1 mm below the superior limbus in bilateral cases and the same level with the other eyelid in unilateral cases, in the primary position of gaze. Postoperative eyelid level beyond these limits was defined as surgical failure. The mean follow up was 16.3 months (6-38 months) and the mean age was 5.48 years (1-24 years). Thirty were male and 26 were female patients. Surgical failure occurred in 9 of 18 (50%) cases in group 1, in 5 of 24 (20.8%) cases in group 2, and in 5 of 38 (13%) cases in group 3 during the follow-up period after adequate eyelid elevation had been achieved just after the operation. The difference between surgical success rates in group 1 and group 2 (p = 0.047) and group 1 and group 3 (p = 0.003) was statistically significant. However, the difference between group 2 and group 3 did not reach statistical significance. Suturing the silicone rod to the tarsal plate increases the surgical success rates of frontalis suspension surgery for congenital ptosis. Suturing with polybutylate-coated braided polyester, even though statistically insignificant, seems to be more effective than suturing with monofilament polypropylene.