Evaluation of Polybutylate-Coated Braided Polyester (Ethibond) Sutures for Levator-Advancement Blepharoptosis Repair

Purpose. To evaluate the efficacy and safety of polybutylate-coated braided polyester (Ethibond* 5-0) suture for levator aponeurosis suturing to the anterior tarsal surface in involutional blepharoptosis repair surgery. Methods. Ten consecutive patients (16 eyes) with acquired blepharoptosis which resulted from levator aponeurosis dehiscence with good levator function had gone through surgery and were followed up for, at least, one year. Results. There was no significant change between postoperative MRD1 measurements. No serious complications, such as infection of the sutures, inflammation, granuloma formation or ptosis recurrence, were registered. Conclusion. Polybutylate-coated braided polyester (Ethibond* 5-0) suture is a safe and effective material for involutional blepharoptosis repair surgery. 1. Introduction Involutional blepharoptosis occurs in the elderly population as a result of levator aponeurosis dehiscence from the anterior tarsal surface, which stretches or thins the aponeurotic fibers, and results in a lowered upper eyelid position and obstruction of the superior visual field [1–3]. Clinically, the patient presents with a lower upper eyelid position, superior migration of the upper eyelid crease and normal levator muscle excursion. Recruitment of the frontalis muscle to raise the eyebrow and compensate for loss of the superior visual field sometimes occurs, and contralateral eyelid retraction may be apparent in cases of unilateral or asymmetric ptosis. Surgical repair is usually required to reattach the levator aponeurosis to the anterior face of the tarsal plate.One to three sutures are necessary. Suture materials that are used for this purpose include 6-0 silk, 6-0 or 5-0 polypropylene (Prolene*), 6-0 or 5-0 polyglactin, and 910 (Vicryl*). Each material has advantages as well as disadvantages for ptosis surgery. The purpose of this study is to evaluate the efficacy and safety of polybutylate-coated braided polyester (Ethibond* 5-0; 8.0？mm, 1/4？c, spatula, Ethicon*, Somerville, NJ, USA) for suturing the levator aponeurosis to the anterior tarsal surface in involutional blepharoptosis repair surgery. Ethibond is a very soft and easy to use multifilament suture. Ethibond knots are less bulky than knots of other suture materials [4]. The use of the nonabsorbable Ethibond reduces the risk of knots releasing as well as of ptosis recurrence. However, the nonabsorbable and multifilament structure of Ethibond has been reported to lead to infection, inflammation, or granuloma formation [5–8]. 2. Methods Ten consecutive patients with acquired