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Imtiaz Chaudhry, Osama Al-Shaikh, Waleed Al-Rashed, Farrukh Shamsi, Yonca Arat, Milton Boniuk; Use of Histoacryl as a Spacer in the Recession of Upper Eyelid Retraction. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6378.
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Upper eyelid retraction may occur as a manifestation of infiltrative disease such as thyroid eye disorder, previous trachoma, surgery, or trauma. The condition may be associated with dry eye syndrome, cosmetically unacceptable appearance and corneal compromise. Over the years numerous techniques for the correction of upper eyelid retraction have been described with or without a spacer. In general, spacer material improves the predictability of the surgery. Purpose of this study is to describe a novel technique of upper eyelid recession by the use of Histoacryl (N-butyl-2-cyanoacrylate) as a spacer.
A retrospective, interventional, non-comparative case study of patients having undergone bilateral or unilateral upper eyelid recessions and the use of Histoacryl thick layer instead of a spacer at the bed of recessed upper eyelid was performed to assess the efficacy of Histoacryl in the management of moderate to severe upper eyelid retraction. Dry eye symptoms, scleral show, lagophthalmos, and keratopathy were evaluated along with cosmetic outcome.
There were 22 patients (16 male, avg age 53.5 yrs, 16 bilateral) who underwent upper eyelid recession for thyroid eye disease-related upper eyelid retraction (10), trachomatous scarring-related upper eyelid retraction (6), facial nerve palsy (2), ptosis overcorrection or trauma-related upper eyelid retraction (2). Average operating time was 15 minutes for unilateral cases and 30 minutes for bilateral cases. Post-operative eyelid height was predictable in 20 (91%) patients. The main intraoperative advantages were the shortened surgical time, minimal bleeding, less swelling and faster recovery. Both the height and contour were predictable with preserved upper eyelid crease without the need for any spacer thus less postoperative eyelid thickening and reaction. Improvement of dry eye symptoms, scleral show, lagophthalmos, and keratopathy were noted in all patients. Eyelid symmetry was achieved in 18 (81.8%) of patients. Average follow-up was 11.2 months (range 2 to 28).
Histoacryle glue can be used instead of spacer material for a predictable recession of upper eyelid retraction due to different causes. This novel method of upper eyelid recession can decrease the operative time and cut the cost of the surgery associated with use of spacer materials.
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