Purpose: To evaluate the outcome of eyelid retraction surgery in thyroid-rela ted orbitopathy (TRO) patients in 2 different surgical settings: done simultaneo usly with orbital decompression or as a staged procedure a...Purpose: To evaluate the outcome of eyelid retraction surgery in thyroid-rela ted orbitopathy (TRO) patients in 2 different surgical settings: done simultaneo usly with orbital decompression or as a staged procedure after orbital decompres sion. Design: Retrospective, comparative, nonrandomized clinical study. Particip ants: Ninety-six patients (158 eyes). Methods: A review of electronic medical r ecords of TRO patients who underwent surgery for upper eyelid retraction and orb ital decompression at the Jules Stein Eye Institute in 1999 to 2003 was performe d. Data regarding eyelid position, comprehensive eye examination, surgical outco me, and complications were analyzed. Main Outcome Measures: Anatomical and funct ional success based on margin reflex distance (MRD1; ≤5 mm was graded as mild r etraction; > 5mm and < 7 mm, moderate; and > 7 mm, severe), and patients’discom fort. Results: One hundred fifty-eight eyelid retraction surgeries were perform ed on 96 TRO patients (18 male and 78 female; mean age, 48 years); mean follow u p time was 15 (±12) months. Group 1 consisted of patients undergoing simultaneo us eyelid retraction surgery and orbital decompression and comprised 97 cases (s urgeries). Group 2 included 61 cases of staged surgery: orbital decompression an d eyelid retraction at a later stage. The groups had similar surgical outcomes, and >85%had a better eyelid position postoperatively. Reoperation rates for res idual or recurrent eyelid retraction were similar, overcorrection was higher in group 2 (5%vs. 0%, P=0.03). Changes in MRD1, lagophthalmos, and exophthalmos w ere similar (P>0.05, independent samples t test). Correction of eyelid retractio n was effective in treating patients’discomfort and exposure keratopathy (P=0.0 4, χ2). No severe complications occurred after orbital decompression or eyelid retraction surgery in this group of patients. Conclusions: Transconjunctival M ller’s muscle recession for correction of eyelid retraction in mild to moderate TRO patients, performed simultaneously with deep lateral wall orbital decompres sion, resulted in acceptable eyelid position in two thirds of our patients. Over correction and consecutive ptosis occurred less often after combined orbital dec ompression and eyelid retraction surgery than after isolated eyelid repositionin g surgery. If confirmed in prospective controlled studies, eyelid-repositioning surgery performed at the time of orbital decompression may decrease the number of total procedures and compress the time needed for surgical rehabilitation.展开更多
文摘Purpose: To evaluate the outcome of eyelid retraction surgery in thyroid-rela ted orbitopathy (TRO) patients in 2 different surgical settings: done simultaneo usly with orbital decompression or as a staged procedure after orbital decompres sion. Design: Retrospective, comparative, nonrandomized clinical study. Particip ants: Ninety-six patients (158 eyes). Methods: A review of electronic medical r ecords of TRO patients who underwent surgery for upper eyelid retraction and orb ital decompression at the Jules Stein Eye Institute in 1999 to 2003 was performe d. Data regarding eyelid position, comprehensive eye examination, surgical outco me, and complications were analyzed. Main Outcome Measures: Anatomical and funct ional success based on margin reflex distance (MRD1; ≤5 mm was graded as mild r etraction; > 5mm and < 7 mm, moderate; and > 7 mm, severe), and patients’discom fort. Results: One hundred fifty-eight eyelid retraction surgeries were perform ed on 96 TRO patients (18 male and 78 female; mean age, 48 years); mean follow u p time was 15 (±12) months. Group 1 consisted of patients undergoing simultaneo us eyelid retraction surgery and orbital decompression and comprised 97 cases (s urgeries). Group 2 included 61 cases of staged surgery: orbital decompression an d eyelid retraction at a later stage. The groups had similar surgical outcomes, and >85%had a better eyelid position postoperatively. Reoperation rates for res idual or recurrent eyelid retraction were similar, overcorrection was higher in group 2 (5%vs. 0%, P=0.03). Changes in MRD1, lagophthalmos, and exophthalmos w ere similar (P>0.05, independent samples t test). Correction of eyelid retractio n was effective in treating patients’discomfort and exposure keratopathy (P=0.0 4, χ2). No severe complications occurred after orbital decompression or eyelid retraction surgery in this group of patients. Conclusions: Transconjunctival M ller’s muscle recession for correction of eyelid retraction in mild to moderate TRO patients, performed simultaneously with deep lateral wall orbital decompres sion, resulted in acceptable eyelid position in two thirds of our patients. Over correction and consecutive ptosis occurred less often after combined orbital dec ompression and eyelid retraction surgery than after isolated eyelid repositionin g surgery. If confirmed in prospective controlled studies, eyelid-repositioning surgery performed at the time of orbital decompression may decrease the number of total procedures and compress the time needed for surgical rehabilitation.
