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Thiago Machado Nogueira, Allan Christian Pieroni Goncalves, Ana Carolina A Goncalves, Luzia D Silva, Mario L R Monteiro; Comparison Between Pre- and Postoperative Quantitative Analysis of Graves Upper Eyelid Retraction Using Margin Reflex Distance and a Digital Eyelid Image Processing Method. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3107.
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To compare the surgical outcome analysis of upper eyelid retraction (UER) provided by the margin reflex distance (MRD) and a digital image processing contour assessment (DIPCA) method, based on 13 radial midpupil lid distances (MPLDs) each 15° of palpebral fissure according to a previously described method . MRD was obtained from the digitally measured MPLD at the 90° position.
In a prospective randomized interventional study, 21 eyes (12 patients) with UER from inactive Graves Orbitopathy had their eyelid fissure analyzed both by the MRD and a DIPCA method. Exclusion criteria included previous eyelid surgery and strabismus. Patients underwent UER surgical correction by the same surgeon and had their eyelid fissures parameters measured preoperatively and at 1-month follow-up. Eyes were divided in two groups: group 1 composed by eyes with remaining UER (MRD > 5mm) and group 2 without UER (MRD ≤ 5mm) after surgery. Eyes from both groups were then individually compared to a range of normal contour based on data from 29 control eyes from 16 randomly chosen Hospital employees without palpebral abnormalities or previous eyelid surgery (see figures). Patients in both groups were further subdivided according to their postoperative DIPCA. MRD and DIPCA were compared.
Eight eyes were included in group 1 and 13 in group 2. All eyes in group 1 (with remaining UER) had poor results on DIPCA while 5 of the 13 eyes in group 2 (considered normal by MRD) still presented an abnormal lid contour. Eyes with postoperative normal MRD and DIPCA had preoperative MRDs (mean ± SD) of 5.85 ± 0.65mm. Eyes with normal postoperative MRD and abnormal DIPCA had preoperative MRD of 6.73 ± 0.81mm while those with abnormal MRD and DIPCA had 7.28 ± 0.73mm. The comparison of postoperative results obtained by MRD and DIPCA (Fischer exact test, p = 0.006) suggest a significant disagreement between the methods results.
MRD taken alone is an insufficient method for assessment of UER surgical correction at 1-month postoperative stage. Good results in DIPCA and MRD ≥ 5mm were associated with lower preoperative MRD. More aggressive surgical correction of patients with more UER led to postoperative MRD ≤ 5mm, but frequently associated with an abnormal DIPCA. 1. Ophthal Plast Reconstr Surg, 2012. 28(6): p. 429-433
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