Types of materials for frontalis sling surgery for congenital ptosis

Citation: Rosenberg JB, Andersen J, Barmettler A. Types of materials for frontalis sling surgery for congenital ptosis. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD012725. DOI: 10.1002/14651858.CD012725.pub2

What was the aim of this review?
In frontalis sling surgery, the eyelid is connected to the eyebrow under the skin using a variety of materials. This is typically done for congenital ptosis, where the muscle that should open the eye did not develop well. The aim of this Cochrane Review was to find out whether different types of materials used for frontalis sling surgery for congenital ptosis led to different outcomes. Most importantly, we wanted to investigate what materials have the highest success rates.

Key messages
We are unsure which type of material has the highest success rate. There were three included trials, that had examined four different materials. None of the trials examined the same materials as another trial, so the results had to be considered individually. The three trials were small, and because they all compared different materials, there is no way to decide which material is the most successful in treating congenital ptosis.

What did we study in this review?
Congenital ptosis, where one or both eyelids droop at birth, is often caused by poor development of the muscles used to lift the eyelids. Frontalis sling surgery is the most effective surgical treatment. Many materials have been used or are still used in this surgery. The purpose of this review was to look at the 'functional success' rates (defined as widening of the opening between eyelids) of the different materials used in frontalis sling surgery.

What were the main results of this review?
We included three randomized controlled trials which compared frontalis sling materials. Among the three trials, four included materials were evaluated: Gore-Tex, Ethibond suture, Mersilene mesh, and autogenous fascia lata. Two trials included both eyes from the same participant, while the other trial included people with ptosis in one or both eyes. Data from the three studies could not be combined because the materials were different. It remains unclear which type of frontalis sling material has the highest success rate.

How up to date is the review?
We searched for studies that have been published up to 20 June 2018.