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S. Rofagha, S. Seiff; Long-term Results for the Use of Gold Eyelid Load Weights in the Management of Facial Paralysis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1488.
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The placement of gold eyelid load weights to improve passive upper eyelid animation is integral to the management of patients with facial palsy, particularly for patients with long-term paralysis.
Retrospective cohort review. Outcomes after placement of one hundred four (104) gold weights in 94 eyelids implanted by one surgeon from 1986 to 2000 were evaluated. The primary outcome measures were improvement in corneal exposure and visual acuity after weight placement. Secondary outcome measures included weight retention, or time to removal, as well as rates of adverse effects and complications.
Mean time of follow-up was 43.37 +41.40 months (range 1-53 months). Visual acuity and corneal compensation improved after weight placement (p=0.0001), while the necessary daily ocular care decreased. Overall, 91 of the 94 (97%) 1st time weights implanted were successful in providing improved protection for the patient's eye and decreasing the daily care needs. Weights were successful in 7 of 9 patients (78%) with concomitant trigeminal neuropathy resulting in corneal anesthesia. Eleven weights (10.6%) became exposed and were removed. Kaplan-Meier survival curve analysis predicted a 3% exposure rate at 12 months, 5% at 24 months, 10% at 5 years, which increased to 35% at 153 months. When needed, replacement weights were equally effective in maintaining ocular health.
This study demonstrates that gold eyelid load weights, when used as part of a comprehensive approach to the management of facial palsy, help preserve vision and improve corneal compensation, while minimizing ocular nursing care. The complications are few but, after approximately 5 years, the incidence of weight exposure increases to approximately 10%. The exposure rate continues to increase with longer follow-up intervals. Extruded weights can be replaced multiple times with the expectation that they will continue to provide a good result.
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