Purpose: To investigate the morphologic changes in Supramid Extra suture harvested from patients displaying recurrent ptosis who had undergone a frontalis suspension for congenital ptosis.
Design: Observational case series.
Methods: Using scanning electron microscopy, we examined the morphologic changes in Supramid Extra (S. Jackson Inc, Alexandria, Virginia, USA) harvested from 20 consecutive patients (23 eyelids) with recurrent ptosis who had undergone frontalis suspension. Disintegration was graded as mild, moderate, or severe.
Results: Examination of unused Supramid showed the smooth surface of the sheath and round, well-demarcated polyfilaments on cross section. However, implanted Supramid showed different degrees of disintegration. The surface of the sheath had a rough texture with cracks and peeling. On cross section, an accumulation of debris among the polyfilaments and irregular architectures with decreased diameters of the polyfilaments were noted in some cases. On the surface of polyfilaments, different degrees of debris were noted in all cases. The degree of the changes was not exactly correlated with either the time of the recurrence or the duration of implantation. However, as the duration of implanted Supramid increased, greater changes on the surface of the sheath were noted. With implantation of less than 37 months, mild changes (44%) were predominant; between 37 and 48 months, moderate changes (60%) were noted, and with more than 48 months of implantation, severe changes (44%) were predominant.
Conclusions: Supramid undergoes morphologic degradation by hydrolysis after implantation. This change might be considered one of the possible factors that facilitate the recurrence of ptosis.