Área Técnica: Órbita
A COMPARATIVE STUDY BETWEEN FULL-THICKNESS BLEPHAROTOMY VS. TRANSCONJUCTIVAL EYELID LENGTHENING TECHNIQUE FOR CORRECTION OF UPPER EYELID RETRACTION IN GRAVES’ORBITOPATHY
To randomly compare the outcome of the full-thickness blepharotomy and the transconjunctival lid lengthening surgical approach to correct upper eyelid retraction (UER) in patients with Graves’ orbitopathy (GO).
Prospective randomized interventional study. After ophthalmic examination, assessment of ocular surface disease index (OSDI) and photography, 27 GO patients with uni or bilateral UER based on the margin reflex distance (MRD) were randomly allocated to either group 1, that underwent a graded full-thickness blepharotomy, or group 2 operated using a transconjunctival Müller muscle recession and graded levator palpebrae superior disinsertion. Six months after surgery all 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 from a normal control group. Outcome in both groups was compared.
Forty-seven eyelids of 27 patients (19 female, mean age 42.0 ± 9.03 years) with lid retraction were included. Twenty-seven eyelids (15 patients) were allocated to group 1 and 20 eyelids (12 patients) to group 2. Surgical procedure averaged 37.46 ± 5.73 minutes in group 1 and 32.70 ± 8.39 minutes in group 2. Based on the MRD, 93% of eyelids in group 1 and 85% in group 2 were within normal range after surgery. Based on the lid contour, 63% of the eyelids in group 1 and 55% of the eyelids in group 2 were labeled “within normal range”. Both groups had significant postoperative improvement in OSDI scores and no surgical complications were registered. No significant difference was observed in any comparison.
Both surgical techniques were equally safe and effective in the treatment of UER from GO. In both groups patients with greater UER presented worse postoperative contour outcomes compared to eyes with smaller amount of UER.