Surgical outcome of upper and lower lid retraction correction using Novel Filamentous Knitted Polyester Fabric in Thyroid Eye Disease

Abstract

Purpose : To assess the use of a novel filamentous knitted polyester fabric (FKPF) in thyroid eye disease (TED) lid retraction repair as an effective surgical method to preserve eyelid function and cosmesis.

Methods : A prospective, interventional case study of surgical outcomes in 14 TED cases with upper and lower eyelid retraction that underwent repair with use of a FKPF spacer. Inclusion criteria were inactive phase of TED based on Rundle’s curve and a Clinical Activity Score (CAS) of 0 out of 7. Follow-up period for all cases was 7-months.

Surgical technique of the upper eyelid retraction repair involved partial dissection of the levator palpebrae superioris (LPS) and muller’s muscle, which were then recessed from the tarsal plate. LPS was displaced distally to create a semilunar gap, and FKPF was placed as a spacer to prevent LPS reattachment to the tarsal plate.

A conjunctival approach was taken for the lower eyelid retraction repair with an incision along the lower border of the tarsal plate. The lower eyelid retractor was dissected from the tarsal plate to create a semilunar gap, and the FKPF was placed as a spacer between the lower border of tarsal plate and the lower eyelid retractors.

All upper eyelid retraction repairs used FKPF spacer 26 mm in length, and a summative central width scleral show, base of 5mm and additional 3mm. All lower lid retraction repairs used a 25 mm FKPF spacer with a central width of 7 mm. Post-operative MRD1, MRD2, scleral show, and palpebral fissure height (PFH) were measured at the 7-month follow up.

Results : Pre-operative measurements to post-operative results revealed: MRD1 was reduced from 7-8.34 mm to 3.8-4.55 mm; scleral show reduced from 2.8-3.3 mm to 0 mm; MRD2 was reduced from 7-8.50 mm to 4.5-5.0 mm; PFH was reduced from 16-17.50 mm to 10.50-11.25 mm. At 6-month follow-up, there were no reported post-operative infection or extrusion.

Conclusions : FKPF is an inert, readily available, cost-effective material that shows promise in lid retraction repair. In our study, all lid retractions were repaired with no post-operative complications and met the functional and cosmetic purpose of the intervention. All patients reported high satisfaction with the outcome of the surgery. Due to its availability and non-reactive nature, FKPF offers a potential alternative to underserved areas to increase accessibility.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.