 |
The Ophthalmology Unit, Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak. |
| The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia. |
aCase 2 Answers
by Dr. Chua
This 6-year-old boy underwent frontalis suspension for congenital ptosis 2 years ago. The material used was mersilene mesh. Since the operation, he had had two abscesses removed from the wound at the incisions on two occasions. He returned recently because of a swelling in his forehead.
a. What is mersilene mesh?
It is made from polyethylene terephthalate. It is very flexible and compliant with great strength and non-absorbable. It is porous and acts as a permanent scaffold for fıbrovascular ingrowth and is well-integrated into surrounding tissue.The use of mersilene mesh for frontalis suspension was first described in 1989. 1
b. What is the possible diagnosis shown here?
Mersilene mesh granuloma.
This is especially common if the mersilene mesh is not burying deeply enough into the plane of the frontalis muscle.
c. What are the common complications with mersilene mesh when used for frontalis suspension?
Granuloma formation, infection and extrusion are complications that can occur with mersilene mesh.2, 3, 4 These problems are especially likely if the mersilene mesh is not sited deep enough within the tissue. It is recommended that the knots of the sling should be made small and the subcutaneous tissue layer be meticulously sutured.
d. What is the best material for frontalis suspension?
Autogenous fascia lata is regarded as the 'gold standard' for brow suspension. lt is well tolerated by the body and remains biologically intact without absorption or cellular reactions. The disadvantages are that fascia harvesting is a separate procedure and children less than 3 years of age are not suitable as they don't have adequate tissue.
e. How would you manage the patient?
Excision of the skin and underlying tissue5 (see picture below). The tissue is sent for culture and sensitivity for any possible infection.
Reference:
1. Downes RN, Collin RO. The Mersilene mesh sling a new concept in ptosis surgery. Br J. OphthalmoL 1989:73:498-501.
2. Mutlu FM, Tuncer K, Can C. Extrusion and granuloma formation With Mersilene Mesh Brow Suspension Ophthalmic Surg Lasers 1999; 30: 47-51.
3. Whitehouse GM, Grigg JR, Martin FJ. Congenital ptosis: results of surgical management. Aust N Z J Ophthalmol. 1995 Nov;23(4):309-14.
4. Mehta P, Patel P, Olver JM. Functional results and complications of Mersilene mesh use for frontalis suspension ptosis surgery. Br J Ophthalmol. 2004 Mar;88(3):361-4. Review.
5. Mehta P, Patel P, Olver JM. Management of Mersilene mesh chronic eyelid complications: a systematic approach.
Eye. 2004 Jun;18(6):640-2.
