COMPARATIVE STUDY OF USING AUTOGENOUS FASCIA LATA SLING VERSUS BANKED HUMAN SCLERA SLING FOR CORRECTION OF CONGENITAL PTOSIS

Background: Congenital ptosis has physical, functional, and psychological consequences. The method of repair depends on treatment goals, the underlying diagnosis, and the degree of levator function which is the most important eyelid measurement in term of surgical planning. Frontalis suspension surgery is well accepted as the procedure of choice for patients (congenital or acquired etiologies) with severe ptosis and poor levator function. Autologous fascia lata is considered one of the best materials for Frontalis suspension surgery due to its low complications rate and long term viability and compatibility, but due to long operative time other natural materials may be used as human scleral graft. Objective: To compare surgical efficacy of using autogenous fascia lata sling versus banked human sclera sling for correction of congenital ptosis with poor levator function. Patients and Methods: A randomized prospective comparative pilot study was conducted on forty eyelids in 26 patients with ptosis associated with poor levator function. Patients were examined, operated upon and followed up at Al-Azhar university hospitals in Cairo during the period from March 2019 till December 2020. Patients were divided into two equal groups: Group A included eyelids in 13 patients (7 bilateral & 6 unilateral), corrected by frontalis sling using autologous fascia lata Group B included eyelids in 13 patients (7 bilateral & 6 unilateral), corrected by banked scleral graft sling. Patients were prepared by taking full history, complete ophthalmic examination, ptosis assessment by measuring margin reflex distance [MRD1], palpebral fissure height [PFH], levator function, and Lid crease. Lid position on down gaze, cover test and Bell’s phenomenon were also assessed. Functional outcomes (MRD1 & PFH) and cosmetic outcomes (Symmetry, lid crease and contour) and complication rates were compared. Results: After a follow up period of at least 6 months, postoperative outcomes showed no statistically significant difference regarding MRD1 and PFH. Percentage of excellent cosmetic outcomes for group A regarding lid contour was 70%, lid height symmetry 75% and lid crease appearance was 80%. Corresponding figures for group B patients were 60%, 65 % and 65% respectively. None of cases had recurrence or serious complications. Conclusion: Banked scleral graft in frontalis suspension has comparable results to the autologous fascia lata with the advantages of shorter operative time and avoiding the need for a second surgical site with its potential morbidity. Longer follow up period is required to confirm whether scleral slings will confer long lasting ptosis correction.