JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2017.58.1.7 jkos-58-7 Original Article Using 17-gauge Spinal Anesthesia Needle as an Insertion Guide for Frontalis Sling Surgery with Silicone Rod LeeWon Sup M.D ChoiYoun Joo M.D Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea Address reprint requests to Youn Joo Choi, MD Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, #150 Seongan-ro, Gangdonggu, Seoul 05355, Korea Tel: 82-2-2224-2274, Fax: 82-2-470-2088 E-mail: ophdrchoi@gmail.com 08 2017 30 8 2017 58 1 7 12 8 9 2016 23 10 2016 15 12 2016 Copyright © 2017 Korean Ophthalmological Society 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

In this study we investigated the surgical outcome and effectiveness of using a 17-gauge spinal anesthesia needle for guiding insertion of the silicone rod in frontalis sling surgery for patients having severe myogenic or neurogenic ptosis with risk of exposure keratopathy.

 Methods

This study included on 8 patients (11 eyes) who previously received frontalis sling surgery with a 17-gauge spinal anesthesia needle because of severe myogenic or neurogenic ptosis with risk of exposure keratopathy. We investigated the technique, surgical outcome, and clinical features following frontalis sling surgery, and evaluated the advantages of using a 17-gauge spinal anesthesia needle.

 Results

The mean age of patients was 54 years. Third nerve palsy was the most common etiology in severe ptosis with risk of exposure keratopathy (5 of 8, 62.5%). Main advantages of the 17-gauge spinal anesthesia needle are smaller skin incision that allows for minimal damage during tissue passage and easy guide for insertion. Other advantages included sterilization, minimizing infections, sharpness without distortion because it is disposable, and economic value. The mean follow-up period was 21.4 months, and the upper lid margin of all patients was adequately high above the pupil margin. Additionally, no major complications were observed in the patients.

 Conclusions

Frontalis sling surgery with a silicone rod is a safe and effective method for patients with severe myogenic or neurogenic ptosis with risk of exposure keratopathy. The 17-gauge spinal anesthesia needle is useful and economical in frontalis sling surgery for guiding insertion of the silicon rod as an alternative option to the Wright needle.

 17-gauge spinal anesthesia needle Exposure keratopathy Frontalis sling Ptosis Silicone rod References CrawfordJSRepair of ptosis using frontalis muscle and fascia lata: a 20-year reviewOphthalmic Surg19616611124 DavíGModoratiGBrancatoRA disposable needle for frontalis suspension surgery in congenital ptosisOphthalmic Surg Lasers19616611124 GoelSBurkatCNThe 18-gauge needle: an innovative simple tool for frontalis sling surgeryOphthal Plast Reconstr Surg19616611124 AlhadyMNgoCTTanAKChuaCNUse of 18-gauge intravenous catheter needle for frontalis suspension in children with congenital ptosisEye (Lond)19616611124 LiuDA modified fascia needleArch Ophthalmol1989107769 WagnerRSMaurielloJA Jr Nelson LBTreatment of congenital ptosis with frontalis suspension: a comparison of suspensory materialsOphthalmology19616611124 Van Sorge AJDevogelaereTSotodehMExposure keratopathy following silicone frontalis suspension in adult neuro- and myogenic ptosisActa Ophthalmol19616611124 LelliGJJrMuschDCFruehBRNelsonCCOutcomes in silicone rod frontalis suspension surgery for high-risk noncongenital blepharoptosisOphthal Plast Reconstr Surg19616611124 BernardiniFPdeConciliis CDevotoMHFrontalis suspension sling using a silicone rod in patients affected by myogenic blepharoptosisOrbit19616611124 AhnJKimNJChoungHKFrontalis sling operation using silicone rod for the correction of ptosis in chronic progressive external ophthalmoplegiaBr J Ophthalmol19616611124 ChoiYJKimYDFrontalis suspension using a silicone rod in blepharoptosis patients with poor ocular motilityJ Korean Ophthalmol Soc19616611124 KarslioğluSSerinDZiylanSSimple alternative to the Wright needle in frontalis sling surgeryOphthal Plast Reconstr Surg19616611124 Tables

Clinical features of 8 patients that underwent frontalis sling with silicone rod using 17-gauge spinal needle as insertion guide

No Sex/Age Laterality Associated disease Pre Op MRD1 Op procedure* Post Op MRD1 Complication F Follow- up (month)
1 M/34 Rt Oculomotor nerve palsy 0 Pentagonal (closed) +3 Transient SPK 38
2 F/65 Both Chronic progressive external ophthalmoplegia -3/-3 Pentagonal (closed) +1.5/+1.5 Transient SPK 32
3 F/32 Both Myotonic dystrophy -2/-1.5 Pentagonal (open) +1.5/+1.5 None 28
4 M/75 Lt Oculomotor nerve palsy with blepharoplasty 0 Pentagonal (open) +2.5 None 6
5 F/16 Both Congenital 0/+0.5 Pentagonal (open) with blepharoplasty +2.5/+2.5 Transient SPK 7
6 F/57 Rt Oculomotor nerve palsy +0.5 Pentagonal (open) with blepharoplasty +3 None 24
7 M/42 Rt Oculomotor nerve palsy 0 Pentagonal (closed) +2.5 None 20
8 F/51 Lt Oculomotor nerve palsy -0.5 Pentagonal (open) with blepharoplasty +2 None 16

Pre Op = preoperation; Op = operation; MRD1 = margin reflex distance 1; Post Op = postoperation; Rt = right; Lt = left; SPK = superficial punctate keratopathy.

Open = eyelid crease incision; closed = supralash stab incision.

 Figues

Application of the 17-gauge spinal anesthesia needle. (A) The 17-gauge spinal anesthesia needle bended like Wright needle. (B) The needle attached to silicone rod is inserted to 17-gauge spinal anesthesia needle as an insertion guide. (C, D) 17-gauge spinal anesthesia needle is applied to operation as an insertion guide.

Comparison of Wright needle, 17-gauge spinal anesthesia needle, 18-gauge hypodermic needle (from the bottom to up). See width, length, inclined plane at the end, and the degree of sharpness.