The Combined Use of Silicone and Green Braided Polyester ‎Suture (Ethibond) versus ‎Silicone or Ethibond Alone for Frontalis ‎Suspension Surgery in Children

Figures & data

Table 1 The Preoperative Characteristics of the Three Studied Groups

Variables	Total	Silicone	Ethibond	Double Sling	P
	N= 49 Patients	n=16 Patients	n=18 Patients	n= 15 Patients
Age (years):
● Mean ± SD	5.36+_3.3	5.7±3.8	5.3±3.6	5.6±3.2	0.79
● Median (IQ range)	(1–15)	6(1–15)	4.5(1–15)	5.8(1–12)
Sex:
● Male	29(59.2)	10 (62.5%)	11(61%)	8 (53%)	0.8
● Female	20(40.8)	6 (37.5%)	7(39%)	7 (47%)
Degree of ptosis (mm)
Mean ± SD	3.5±0.6	3.45±0.5	3.56±0.7	3.34±0.8	0.72
Range	(3–5)	(3–4)	(3–5)	(3–5)
Laterality:
● Unilateral	28(57.1)	10 (62.5%)	11(61%)	7(47%)	0.8
● Bilateral	21(42.9)	6 (37.5%)	7(39%)	8(53%)
Follow up (months)					0.95
Mean ± SD	24.02±6.1	24.25±5.6	23.3±7.6	22.6±7.0
Range	(18–36)	(18–36)	(18–36)	(18–36)

Table 2 The Changes in MRD1 Measurements in the Three Studied Groups

MRD1(mm)	Total	Silicone	Ethibond	Double Sling	P
	(N= 70 Eyelids)	(n=22 Eyelids)	(n=25 Eyelids)	(n=23 Eyelids)
	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD
	Range	Range	Range	Range
Pre-operative
Mean ± SD	0.5±0.6	0.5±0.5	0.4±0.7	0.54±0.6	0.71
Median (range)	1 (−1/1)	1(0–1)	0.5(−1/1)	1 (−1/1)
1st month PO (Initial PO)	3.1±0.6 (2–5)	3.2±0.6 (2–4)	3.2±0.7 (2–5)	3.07±0.75 (2–4)	0.95
6 month	2.97±0.46 (2–4)	3.02±0.6 (2–4)	2.94±0.52 (2–4)	2.95±0.42 (2–4)	0.82
12 month	2.84±0.5 (1.5–4)	2.95±0.6 (2–4)	2.75±0.5 (1.5–3.5)	2.8±0.4 (2–4)	0.98
Last follow up visit (Final PO)	2.64±0.5 (1–3)	2.6±0.52 (1.5–3)	2.5±0.4 (1–3)	2.9±0.65 (2–3)	0.38
P1		<0.0001*	<0.0001*	<0.0001*
P2		<0.0001*	<0.0001*	0.002*

Notes: P, difference among the three groups regarding preoperative MRD1 and PO MRD1 at each visit; P1, difference between preoperative MRD1 and initial PO MRD1; P2, difference between initial PO MRD1 and final PO MRD1 for each group; *statistically significant.

Abbreviations: MRD1, margin reflex distance-1; PO, postoperative.

Figure 1 Photos of a patient with severe left ptosis who was operated on using double sling technique. (A) Preoperative photo. (B) Photo taken in the early follow up period showing good initial postoperative outcome. (C) Photo taken 18 months after the surgery with good final postoperative outcome.

Table 3 Differences in the Surgical Outcomes Between the Studied Groups

Outcome	Total	Silicone	Ethibond	Double Sling	P	P	P
	(N= 70 Eyelids)	(n=22 Eyelids)	(n=25 Eyelids)	(n=23 Eyelids)	(Silicone/Ethibond)	Silicone/Double Sling	Double Sling/Ethibond
	F(%)	F (%)	F (%)	F (%)
Good	37(52.9)	13 (59%)	11(44%)	13 (57%)	0.31	0.86	0.39
Fair	18(25.7)	4 (18%)	6 (24%)	8 (35%)	0.52	0.21	0.52
Poor	15(21.4)	5 (23%)	8 (32%)	2 (8%)	0.48	0.19	0.047*

Note: *Statistically significant.

Abbreviations: F, frequency; %, percentage.

Figure 2 Column chart showing the outcomes of surgery for the three studied groups assessed at the last follow up visit.

Table 4 Postoperative Symmetry in Bilateral Cases

	Total	Silicone	Ethibond	Double Sling	P
	N=21	(n=6)	(n=7)	(n=8)
	F (%)	F (%)	F (%)	F (%)
Symmetry in bilateral cases
→ Symmetrical	17(80.9)	5(83.4%)	5(71.4%)	7(87.5%)	0.7
→ Asymmetrical	4(19.1)	1(16.6%)	2(28.6%)	1(12.5%)

Notes: N, total number of bilateral cases in each group in which the asymmetry was assessed; n, number of bilateral cases in each group.

Abbreviations: F, frequency; %, percentage.

Table 5 The Postoperative Main Complications in the Three Studied Groups

Complications	Silicone	Ethibond	Double Sling	P
	(n=22)	(n=25)	(n=23)
Granuloma [number (percentage)]	0	2(8%)	1(4.3%)	0.1
Infection [number (percentage)]	0	2(8%)	2(8.7%)
Total wound-related complications	0	4(16%)	3(13%)
Recurrence [number (percentage)]	8(36.4%)	11(44%)	6 (26.1%)	0.4
Mean time of recurrence (months)	15.4±3.2	14.8±6.2	12.3±4.5	0.5

Table 6 The Results of Some Studies Conducted for the Use of Silicone Rod for Frontalis Suspension Surgery

Study	Number of Eyelids or Patients	Follow Up (Months)	Recurrence	Wound-Related Complications
Ben Simon et al^Citation17	27 patients	20 months	44%	0%
Morris et al^Citation23	110 eyelids	17 months	–	9%
Lee et al^Citation24	63 patients	36 months	11% (unilateral) 29% (bilateral)	—
Carter et al^Citation25	35 patients	22 months	7%	5%
Buttanri et al^Citation26	80 eyelids	16.3months	23.75%	0%
Rizvi et al^Citation27	56 eyelids	12 months	4%	2%

Table 7 The Results of Some Studies Conducted for the Use of Ethibond for Frontalis Suspension Surgery

Study	Number of Eyelids	Follow Up (Months)	Recurrence or Residual Ptosis	Wound-Related Complications
Molinari et al^Citation28	43	38.6	–	6 (13.9%)
Bajaj et al^Citation29	30	16±3.24	17%	2 (13%)
Wasserman et al^Citation8	11	8	27.3%	1 (9.1%)

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