Use of autogenous fascia lata slings in the surgical correction of ptosis: a systematic review of the literature and meta-analysis

• Published in: British journal of oral & maxillofacial surgery 2024-02, Vol.62 (2), p.128-139
• Main Authors: Ahmad, Reddin, Rehman, Umar, Sohaib Sarwar, Mohammad, Ahmed, Zahra, Adebayo, Oluwasemilore, Brennan, Peter A.
• Format: Article
• Language: English
• Subjects: Autogenous fascia lata; Eyelid; Fascial sling; Frontalis suspension; Ptosis surgery
• ISSN: 0266-4356; 1532-1940
• DOI: 10.1016/j.bjoms.2023.11.013

Ptosis is an abnormally low-positioned upper eyelid. Management depends on severity, aetiology, and function of the levator palpebrae superioris muscle (LPS). This review evaluates the success of autogenous fascia lata slings (AFLS) in the surgical management of ptosis, together with complication and reoperation/revision rates. A literature search was conducted on PubMed, Google Scholar PROSPERO, Dynamed, DARE, EMBASE, Cochrane, and BMJ databases (PROSPERO registration: CRD42023475090), and 30 studies (3690 patients and 5059 eyes) were included. The average age of the patients was 14.2 years with a ratio of male:female patients of 1:0.7. A total of 2532 eyes had undergone a fascial sling with autogenous fascia lata. The average follow-up period was 32.6 months. Improvement in the margin to reflex distance 1 (MRD1) with fascial sling surgery was 2.79 mm. The rate of complications from surgery involving autogenous fascia lata was 21.3%. The most common complications included lagophthalmos (19.8%), residual ptosis (11.5%), and corneal damage (10.4%). The reoperation rate was 13.4%. Most common indications for reoperation were cosmetic, with asymmetry (18%), lid crease abnormalities (30%), and upper eyelid trimming (18%). The overall complication rate in AFLS patients was 20% (95% CI: 6 to 35, p