COMPARISON OF SUPRAMAXIMAL LEVATOR PLICATION WITH TARSO FRONTALIS SLING BY SILICON ROD IN SEVERE PTOSIS WITH POOR FUNCTION LEVATOR PALPEBRAE SUPERIORIS

BACKGROUND Drooping of upper lid is commonly known as ptosis. It may be unilateral or bilateral. It may be congenital or acquired. We wanted to evaluate the functional and cosmetic correction, complications and recurrence of levator plication and compare the same with tarso frontalis sling with silicon rod in severe ptosis with poor function LPS. METHODS This is an institution based prospective, randomized, international comparative study of 40 eyes over a period of two years. Group A comprised of 20 eyes operated with levator plication of which three interrupted vertical mattress sutures with supra maximal plication of LPS. Group B comprised of 20 eyes operated with tarso frontalis sling with silicon rod. RESULTS Out of operated 40 cases, complications included significant inflammation and oedema in 1st post-operative week in plication Gr-A. Scar was more in plication Gr-A. In this study, 6 cases had not satisfactory (gross under correction) result in plication Gr. and one case in Gr. B. This was treated with readjustment of the sling. With respect to uplift or fixed lid height post operatively, comparison between Gr - A and Gr - B results shows that there was good uplift with brow up and brow down in Group B which is statically significant (p<0.001). All the patients were followed up for six months to one year. CONCLUSIONS In severe ptosis correction, tarso frontal sling is superior than supramaximal plication of LPS with regard to complications like inflammation, oedema, scar and cosmetic lid height. From technical point of view, surgical procedure is much easier (minimal invasive) in Gr-B. with a period of one year follow up.