i have a one month grandson with ptosis congenital, what do you think about the fascia in infants?
Congenital Ptosis - Fascia Lata for a Newborn?
Doctor Answers (4)
Congenital Ptosis Repair
Regarding fascia lata for a newborn for congenital ptosis: Fascia lata is an excellent material for slings for congenital ptosis. However it is my preference (and most surgeons) to do a sling made of synthetic material (such as supramid) in young babies and toddlers. When the child is around 4 or 5 years old, I will recommend fascia lata for the sling. Repair at this age is necessary if the child's vision is being blocked and there is the risk of amblyopia or if the the baby has developed a chin up head position in order to see. It is recommended that the baby be followed by a pediatric ophthalmologist throughout this. Good luck!
The key issue here is whether the eyelid is blocking vision.
Fascia lata is an excellent product for frontalis suspension. However for a new born, an easily adjustable silicone sling is often preferred. Experience is essential. I would recommend that your grandson be assessed at a University based medical center by a pediatric ophthalmologist if this had not already happened. If necessary, this individual can also involve the oculoplastic surgeon. Be aware that many pediatric ophthalmologists perform this type of ptosis surgery. Amblyopia or lazy eye can develop quickly if the vision is blocked by the heavy upper eyelid.
Fascia Lata is great, but...
Fascia lata is a great option for a frontalis sling procedure for children, however, you need to make sure your surgeon is experienced in harvesting the tissue, especially in infants.
The most important issue, as Dr. Mohadjer indicated, is timing. Unless your child's visual axis is being compromised [which would adversely affect visual development, a condition termed "amblyopia"], it is best for to wait until at least age 3-4 to consider surgery. This will give your child's eyelid anatomy time to develop to a more mature state which will give more ideal results.
An evaluation by a pediatric ophthalmologist is key in deciding whether "amblopia" is occurring or has a high likelihood of developing, and that needs to happen immediately.
Best of luck
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There are a lot of nuances with congenital ptosis. Timing is very important. Is the ptosis severe enough that it is blocking the child's vision? If so, early surgery is preferred to allow the vision to develop. If this child is clearing his visual axis, and the ptosis is mild, it may be easier to wait until the child is older so that the height of the eyelid can be better adjusted.
That being said, if surgery is necessary there are a few good options to elevate the lid. Fascia lata is often used and has its benefits. In a child that age, this tissue generally comes from a cadaver donor, so there are those issues. In a child at least 2-3 years old, the fascia can be harvested from the child's own leg, although then there are two surgical sites with a host of potential problems, infections, pain, etc. at each one. Fascia is very well tolerated but is very hard to adjust. I tend to prefer silicone slings because they can be adjusted later in life as necessary, but this type of sling is an implant, and it can be infected or extrude later in life too.
More or less, either of these products are generally well tolerated and very acceptable, reasonable options for your grandson. My advice to you is that whatever surgeon you chose, I would go with the sling they use most often and are most comfortable with to ensure you get a good result. Also keep in mind, that as the child ages the sling may need to be replaced, repositioned, and can sometimes even break with time...Usually a secondary surgery is needed later in life...(this may be 20,30, even 40 years later)
Jasmine Mohadjer, MD
Tampa Bay, FL
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