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Preeti J. Thyparampil, Seongmu Lee, Michael Yen; Outcomes And Complications Of Eyelid Gold Weight Implantation For Facial Paralysis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6750.
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To review outcomes and complications of gold weight implantation for facial nerve paralysis.
Patients that underwent upper eyelid gold weight placement from 2003 to 2011 at an academic oculoplastics practice were retrospectively analyzed. Data analyzed included patient demographics, indications for surgery, complications, and short-term and long-term outcomes.
Eighteen gold weights and 1 platinum weight were placed in 19 patients (5 men and 14 women) between 2003 and 2011. The average age at the time of surgery was 55 years (range 3-87, median 62). The average size of the weight placed was 1.2g. The most common indication for surgery was facial nerve paralysis after excision of an acoustic neuroma (8/19), followed by congenital facial nerve paralysis (2/19). Other indications were facial nerve paralysis due to Ramsay-Hunt Syndrome, polio, trauma, stroke, and after excision of tumors including melanoma, parotid gland tumor, and brainstem meningioma. In 5 patients who had previously undergone weight implantation, reasons for reimplantation included weight extrusion (2/5), incorrectly sized weights (2/5) and allergic reaction to gold (1/5). There were no intraoperative complications. Long-term complications were weight extrusion in 2 patients (at 1 month and 4 months postoperatively). Another patient had the weight removed in order to undergo an MRI. Average preoperative lagophthalmos was 4.41mm. Average postoperative lagophthalmos was 0.5mm, 1.36mm, 1.57mm, 1.6mm and 1.34mm at 1 day, 1 week, 1 month, 1 year and 2 years respectively. Eighteen patients had preoperative exposure keratopathy, and of the 15 in whom the weight remained in place, 12 had resolution of keratopathy. Three patients had persistent exposure requiring lateral tarsorrhaphy in 2 patients and lower lid ectropion repair in another. The 2 patients with weight extrusion had exposure requiring lateral tarsorrhaphy in one patient and a scleral contact lens in the other. The patient in whom the weight was electively removed had exposure requiring lower lid ectropion repair.
The majority of patients had good short-term and long-term improvement in lagophthalmos and corneal exposure. Overall, gold weight implantation was an effective method of treating paralytic lagophthalmos in this series.
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