A Randomized Clinical Trial of Two Methods of Fascia Lata Suspension in Congenital Ptosis Abbas Bagheri, M.D., Maryam Aletaha, M.D., Hossein Saloor, M.D., and Shahin Yazdani, M.D. Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran Purpose: To compare the results of 2 methods of upper eyelid sling placement with autogenous fascia lata in the treatment of congenital ptosis. Methods: In a randomized clinical trial, patients with congenital upper eyelid ptosis and poor levator function (4 mm) were randomly assigned to either of 2 methods of upper eyelid sling placement: group A, bitriangular fascia sling (modified Crawford method), and group B, monotriangular fascia sling (modified Fox method). Results: This study included 30 upper eyelids (15 eyelids in each surgical group) of 19 patients (8 unilateral and 11 bilateral cases) with congenital ptosis. Mean increase in eyelid fissure height was 2.7  2.3 mm in group A and 3.4  2.2 mm in group B. Change in eyelid fissure in both groups was significant (p  0.001, paired t test) but the intergroup difference was not (p = 0.4, independent sample t test). Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the 2 groups. No patient experienced recurrent ptosis requiring reoperation in either group. Conclusions: The monotriangular method of upper eyelid fascia sling placement can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation, and a shorter period of anesthesia. B lepharoptosis surgery is one of the most common oculoplastic procedures, the aim of which is to clear the visual axis, reducing amblyopia in young patients and improving superior visual fields in adult patients. The secondary goal is to improve appearance by producing symmetric eyelid creases and contours in the upper eyelids. The choice of surgical procedure depends on the function of the levator muscles. With weak levator function, the classic approach is to sling the upper eyelid to the frontalis muscle by an exogenous or autogenous mate- rial. 1– 6 However, supermaximum levator resection or Whit- nall ligament sling has been used by some surgeons. 7,8 Reverse use of protractor muscles (frontalis and orbicularis oculi) as retractors is recommended by others. 9,10 Different materials have been used for eyelid slings, the most popular exogenous ones are silicone rod, 11,12 Mersilene (Ethicon, Blue Ash, OH, U.S.A.) mesh, 13–18 Supramid (S. Jackson, Alexandria, VA, U.S.A.), 19 and Gore-Tex (W.L. Gore and Associates, Newark, DE, U.S.A.). 20 The most commonly used endogenous materials are preserved 21–23 or fresh 24 fascia lata and fascia tempo- ralis 25 ; autogenous palmaris longus tendon 26 and umbilical vein 17 also have been used. Autogenous fascia lata is the preferred material because of its low rate of complica- tions 27,28 and long term viability and compatibility. 29 There is no general agreement on sling configuration; single, double rhomboid, pentagonal, or triangular methods can be used. 1–5 Some believe that the monotriangular method is best for peaked brows and the pentagon or rhomboid type is preferred for diffuse, elevated brows. 5 Others recommend monotriangular (modified Fox method) for children and bitriangular (modified Crawford method) for adults. 1 This study was designed as a prospective randomized clinical trial to compare 2 methods of upper eyelid sling placement with autogenous fascia lata in the treatment of congenital upper eyelid ptosis with poor levator function. METHODS Patients with unilateral or bilateral congenital upper eyelid ptosis who were referred to the oculoplastic service from July 2003 to December 2004 and fulfilled the criteria for sling surgery with autogenous fascia lata were randomly allocated to 1 of 2 surgical groups. Inclusion criteria included weak levator function (4 mm) and age 4 years or older for adequate harvestable autogenous fascia lata. Exclusion criteria included Accepted for publication November 27, 2006. Supported by the Ophthalmic Research Center, Shaheed Beheshti Medical University, Tehran, Iran. None of the authors has any financial or proprietary interest in the subject of this paper. Address correspondence and reprint requests to Dr. Abbas Bagheri, Department of Ophthalmology and Ophthalmic Research Center, Lab- bafinejad Medical Center, Boostan 9 St. Pasdaran Avenue, Tehran 16666, Iran; E-mail: abbasbagheri@yahoo.com DOI: 10.1097/IOP.0b013e3180557479 Ophthalmic Plastic and Reconstructive Surgery Vol. 23, No. 3, pp 217–221 ©2007 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. 217