Introduction to e-PTFE material for the treatment of epicanthalmia in children

       A baby with congenital ptosis can only be cured by surgical correction. On one hand, ptosis affects the child’s aesthetics and can cause low self-esteem, and on the other hand, it covers the pupil and affects the baby’s vision development, putting him at risk for amblyopia. Parents who come to the clinic are eager to get their child operated on and have their ptosis cured as soon as possible. However, the underdeveloped nature of the levator muscle in young children limits the effectiveness of this procedure. In younger children, only frontal flap suspension can be used, but this is associated with more damage, more bleeding, and difficulty closing the eyelid after surgery. This adds to the difficulty of postoperative care for the child and predisposes him to exposure keratitis and hematoma of the brow arch.       The use of suitable materials for frontalis suspension can be designed to avoid the disadvantages of frontalis flap surgery, which is highly invasive and prone to difficult eyelid closure. However, the properties of the implanted material are demanding, requiring good biological properties, chemical stability, and no inflammation or foreign body reaction. It also needs to be resistant to mechanical tension in order to ensure a stable surgical result. By comparing and exploring a variety of implantable materials, experts believe that e-PTFE (expanded polytetrafluoroethylene) is an ideal material that meets the demanding requirements for performing implantable suspension surgery. This material has been used for many years in cardiac and cosmetic implant procedures and its safety has been tested.       Currently, e-PTFE is used clinically for frontalis suspensions with excellent results. Because of the elasticity of the implanted material, the child is less likely to have a significant upper lid delay after surgery and has a more natural appearance. The surgical damage is minimal, the child’s eyelid has a mild local reaction, and recovery is quick. The surgery is also reversible and repeatable, allowing room for future treatment. For example, children who grow up with more developed levator muscles may choose to have another surgery to shorten the levator muscle in a more physiologic manner.       With this in mind, we recommend this procedure for young children with severe ptosis, combined strabismic amblyopia, children who need very minor surgery because of psychological problems, and children with mandibular transient syndrome. It allows for timely amblyopia training while obtaining a good appearance.