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Allan Christian Pieroni Goncalves, Thiago Machado Nogueira, Ana Carolina A Goncalves, Luzia D Silva, Mario L R Monteiro, ; A RANDOMIZED COMPARATIVE STUDY OF SURGICAL CORRECTION OF GRAVES UPPER EYELID RETRACTION THROUGH CONJUNCTIVAL OR BLEPHAROTOMY APPROACH. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4104.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the effectiveness of two surgical techniques for upper lid retraction (ULR) from Graves’ orbitopathy (GO) regarding the accuracy of ULR correction.
In a prospective randomized interventional study, 22 patients (15 women, 40 eyes) with ULR from GO in an inactive stage were allocated to either of two groups: the first to be operated by a graded full-thickness anterior blepharotomy, and the second by a graded posterior (conjunctival) approach. Exclusion criteria included previous eyelid surgery and vertical strabismus. All patients underwent complete ophthalmic examination including upper eyelid margin reflex distance (MRD) (the distance between the upper eyelid margin and the pupil center). ULR was defined as MRD ≥ 5mm. Before surgery the desired MRD measurement for each patient was determined. All surgeries were performed by the same experienced surgeon. After 3-month of follow-up, MRD were measured. The amount of postoperative correction was calculated. The difference between measured and planned MRD was defined as a precision index (PI). The number of eyes with PI ≤ 1 in each group was calculated. Results of the two groups were compared.
Twenty-one eyelids were operated by the anterior approach (group 1) and 19 by the posterior approach (group 2). In group 1 mean ± standard deviation (SD) (in mm) MRD pre-op was 7.26 ±1.55 (range 5-10) and in group 2 was 6.34 ±1.23 (range 5-9). No significant difference was found between the two groups (p=2.07). The mean ±SD for the amount of correction for group 1 was 2.40mm ±1.57 and for group 2 2.68mm ±1.70 (p=-0.540, non-significant). PI (mean ± SD, in mm) was 0.98 ±0.95 (range 0-4) in group 1 and 0.67 ±0.80 (range 0-3) in group 2 (p=1.136, non significant). Sixteen eyes in group 1 and 17 in group 2 had PI ≤ 1.
Surgical correction of ULR by either through blepharotomy or the posterior (conjunctival) approach give similar results regarding both the amount and accuracy of correction when assed by the MRD measurement alone.
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