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Allan Christian Pieroni Goncalves, Thiago Nogueira, Mario R Monteiro; A comparative study of full-thickness blepharotomy vs. transconjunctival eyelid lengthening in the correction of upper eyelid retraction in Graves’ Orbitopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3834.
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To compare the outcome of full-thickness blepharotomy and transconjunctival eyelid lengthening in the correction of upper eyelid retraction (UER) in patients with Graves’ orbitopathy (GO).
Prospective randomized interventional study. Following ophthalmic examination, determination of the ocular surface disease index (OSDI) and photography, 27 patients with UER were randomly assigned to either graded full-thickness blepharotomy (G1) or transconjunctival Müller muscle recession and graded disinsertion of the levator palpebrae superioris muscle (G2). Six months after surgery, patients were reevaluated. Digital images were analyzed with the assistance of customized software. A standardized “normal range” of upper eyelid height and contour was calculated based on healthy controls. The outcome of the two groups was compared.
Forty-seven eyelids of 27 patients (19 female) with UER were included. Twenty-seven eyelids (15 patients) were allocated to G1 and 20 eyelids (12 patients) to G2. On the average, surgery lasted 37.46 ± 5.73 min in G1 and 32.70 ± 8.39 min in G2. Based on the margin reflex distance, 93% of the eyelids in G1 and 85% in G2 were within the normal range after surgery. The corresponding figures for lid contour were 63% and 55%. Both groups displayed significant improvement in OSDI scores. No surgical complications were registered. No significant difference was observed in the overall comparison.
The two surgical techniques were equally effective in the treatment of UER from GO. Postoperative contour outcomes were considerably worse in patients with severe UER than in patients with mild or moderate UER, regardless of group.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Examples of pre- and postoperative photographs and the change of MRD measurements in polar plots. Above: A. severe UER; B. Postop; C. Contour analysis of the upper eyelid shows preoperative upper eyelid (red) outside the normal range of contour (gray) and postoperative upper eyelid (blue) within the normal range of MRD at 90° but outside the normal range of contour. Below. D. Moderate upper eyelid retraction; E. Postop; F. Contour analysis of the upper eyelid shows preoperative upper eyelid outside the normal range of contour and postoperative upper eyelid within the normal range.
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