Reply re: “Conjunctiva-Sparing Posterior Ptosis Surgery

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I would like to thank Drs. Bealka, Somogyi, and Nakra for their interest in our surgical technique and suggested modification.1 I myself have transitioned to using an absorbable 6-0 chromic gut suture for the most of my cases using the conjunctiva-sparing posterior ptosis technique. For the technique as described in my original publication, I prefer having the suture remain in place for at least 7 days to ensure adequate time for healing which chromic gut achieves. Externalization on the skin surface allows easy removal at 1 week postop if desired, alternately the suture can be left to absorb if it is well tolerated. I am glad to hear of the author’s success with fast absorbing gut suture which in my experience can lose its tensile strength prior to 1 week, suggesting healing from the surgery is quite rapid. A buried knot under window pane conjunctiva concerns me as an area potentially vulnerable to breakdown and subsequent ocular surface irritation, but it is encouraging the author’s have found that the conjunctival flap provides a robust barrier to breakdown even over a suture knot. I would like to thank the authors again for their contribution and alternative modification to the technique.
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