Background: The chronic stage in Grave’s orbitopathy is characterised by fibr otic changes within the orbital soft tissues, especially the extraocular muscles . Retraction of the eyelids is a common clinical feature ...Background: The chronic stage in Grave’s orbitopathy is characterised by fibr otic changes within the orbital soft tissues, especially the extraocular muscles . Retraction of the eyelids is a common clinical feature of this phenomenon. To solve this problem several techniques for lengthening the upper eyelid have been described with variable rates of success. In this report we describe our modifi ed Harvey’s technique for the correction of upper eyelid retraction which inclu des a complete recession of the Müller’s muscle/levator complex from the tarsa l plate without the interposition of a spacer. Finally only the skin and the sup erficial orbicularis muscle are sutured. We also report about our results with t his procedure. Methods: 8 patients (1 male, 7 female) with lid retraction in Gra ve’s ophthalmopathy were recorded who had undergone the modified lengthening te chnique by an external approach between 2001 and 2004. Four patients underwent a bilateral procedure and 1 patient showed a significant undercorrection, necessi tating reoperation. So a total of 13 procedures were included in this follow-up study. Beside the common ophthalmological examination, special interest was put in the difference of the two eyelid apertures in primary position pre-and post operatively. Results: Within a follow-up period of at least 3 months we recorde d an averaged lengthening of the upper eyelid of 3.1 mm. The difference of the t wo eyelid apertures in primary position improved from 2.2 mm preoperatively to 1 .0 mm postoperatively. Only 1 patient needed reoperation because of a significan t undercorrection. There were no late overcorrections observed. Conclusions: The modified Harvey’s technique to lengthen the upper eyelid is a safe and effecti ve method to reduce upper eyelid retraction in Grave’s disease. An eventually r equired orbital decompression orextraocular muscle surgery has to be done before the lid surgery.展开更多
Background: Strabismus in thyroid ophthalmopathy is based on a loss of the con tractility and distensibility of the external ocular muscles. Different therapeu tic approaches are available, such as recession after pre...Background: Strabismus in thyroid ophthalmopathy is based on a loss of the con tractility and distensibility of the external ocular muscles. Different therapeu tic approaches are available, such as recession after pre-or intraoperative mea surement, adjustable sutures, antagonist resection, or contralateral Synergist f adenoperation. Patients and Methods: 26 patients with strabismus in thyroid opht halmopathy were operated between 2000 and 2003. All patients were examined preop eratively, then 1 day and 3-6 months (maximum 36 months) postoperatively. Befor e proceeding with surgery, we waited at least 6 months after stabilization of oc ular alignment and normalization of thyroid chemistry. Results: Preoperative ver tical deviation was 10 -44 PD (mean 22), 3 months postoperatively it was-2-10 PD (mean 1.5). Recession of the fibrotic muscle leads to reproducible results: 3.98 ±0.52 PD vertical deviation/mm for the inferior rectus. In the case of a l arge preoperative deviation a correction should be expected, which might not be sufficient in the first few days or weeks; a second operation should not be carr ied out before 3 months. 7 patients were operated twice, 1 patient need three op erations. 4 patients (preop. 0) achieved no double vision at all; 15 patients (preop. 1) had no double vision in the primary and reading positions; 3 patients (preop. 0) had no double vision with a maximum of 5 PD; 1 patient (preop. 7) had double vision in the primary o r reading position even with prisms; and 2 patients (preop. 17) had double visio n in every position. Conclusions: We advocate that recession of the restricted i nferior or internal rectus muscle is precise, safe and effective in patients wit h thyroid ophthalmopathy. The recessed muscle should be fixed directly at the sc iera to avoid late overcorrection through a slipped muscle. The success rate in terms of binocular single vision was 76%and 88%with prisms added.展开更多
文摘Background: The chronic stage in Grave’s orbitopathy is characterised by fibr otic changes within the orbital soft tissues, especially the extraocular muscles . Retraction of the eyelids is a common clinical feature of this phenomenon. To solve this problem several techniques for lengthening the upper eyelid have been described with variable rates of success. In this report we describe our modifi ed Harvey’s technique for the correction of upper eyelid retraction which inclu des a complete recession of the Müller’s muscle/levator complex from the tarsa l plate without the interposition of a spacer. Finally only the skin and the sup erficial orbicularis muscle are sutured. We also report about our results with t his procedure. Methods: 8 patients (1 male, 7 female) with lid retraction in Gra ve’s ophthalmopathy were recorded who had undergone the modified lengthening te chnique by an external approach between 2001 and 2004. Four patients underwent a bilateral procedure and 1 patient showed a significant undercorrection, necessi tating reoperation. So a total of 13 procedures were included in this follow-up study. Beside the common ophthalmological examination, special interest was put in the difference of the two eyelid apertures in primary position pre-and post operatively. Results: Within a follow-up period of at least 3 months we recorde d an averaged lengthening of the upper eyelid of 3.1 mm. The difference of the t wo eyelid apertures in primary position improved from 2.2 mm preoperatively to 1 .0 mm postoperatively. Only 1 patient needed reoperation because of a significan t undercorrection. There were no late overcorrections observed. Conclusions: The modified Harvey’s technique to lengthen the upper eyelid is a safe and effecti ve method to reduce upper eyelid retraction in Grave’s disease. An eventually r equired orbital decompression orextraocular muscle surgery has to be done before the lid surgery.
文摘Background: Strabismus in thyroid ophthalmopathy is based on a loss of the con tractility and distensibility of the external ocular muscles. Different therapeu tic approaches are available, such as recession after pre-or intraoperative mea surement, adjustable sutures, antagonist resection, or contralateral Synergist f adenoperation. Patients and Methods: 26 patients with strabismus in thyroid opht halmopathy were operated between 2000 and 2003. All patients were examined preop eratively, then 1 day and 3-6 months (maximum 36 months) postoperatively. Befor e proceeding with surgery, we waited at least 6 months after stabilization of oc ular alignment and normalization of thyroid chemistry. Results: Preoperative ver tical deviation was 10 -44 PD (mean 22), 3 months postoperatively it was-2-10 PD (mean 1.5). Recession of the fibrotic muscle leads to reproducible results: 3.98 ±0.52 PD vertical deviation/mm for the inferior rectus. In the case of a l arge preoperative deviation a correction should be expected, which might not be sufficient in the first few days or weeks; a second operation should not be carr ied out before 3 months. 7 patients were operated twice, 1 patient need three op erations. 4 patients (preop. 0) achieved no double vision at all; 15 patients (preop. 1) had no double vision in the primary and reading positions; 3 patients (preop. 0) had no double vision with a maximum of 5 PD; 1 patient (preop. 7) had double vision in the primary o r reading position even with prisms; and 2 patients (preop. 17) had double visio n in every position. Conclusions: We advocate that recession of the restricted i nferior or internal rectus muscle is precise, safe and effective in patients wit h thyroid ophthalmopathy. The recessed muscle should be fixed directly at the sc iera to avoid late overcorrection through a slipped muscle. The success rate in terms of binocular single vision was 76%and 88%with prisms added.
