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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.
References
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Table 1.
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 |
Figues
Figure 1.
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.
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