Modified Full-Thickness Blepharotomy for Treatment of Thyroid Eye Disease

Nimitwongsakul, Aree; Zoumalan, Christopher I.; Kazim, Michael

doi:10.1097/iop.0b013e318275b5e2

Cited by 13 publications

(3 citation statements)

References 17 publications

(7 reference statements)

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“…No operation method is without revision procedures, and this applies to blepharotomy also. A re-operation rate of 5 % to 15 % is reported [13,27], and 8-23 % overall over all the different operation methods. It appears to be the case, however, that the chances of a perfect result decrease with each further procedure [29].…”

Section: Discussionmentioning

confidence: 93%

Eyelid Surgery in Gravesʼ Orbitopathy

Hintschich¹

2021

Klin Monbl Augenheilkd

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Patients with Gravesʼ orbitopathy often develop eyelid changes. These may be the result of a volume effect or a malposition. Both dermatochalasis with fat tissue increase and eyelid retraction may lead to functional or aesthetic impairment. The present article reviews indications, timing and principles for corrective eyelid surgery. If at all possible, surgical eyelid correction in Gravesʼ orbitopathy should be performed once the disease became inactive and stabile. Surgical details of eyelid lengthening procedures for upper and lower eyelid retraction are presented. Meanwhile anterior blepharotomy became the primary procedure for upper eyelid lengthening. However, there is no such standard procedure for lower eyelid lengthening, although it is recommended to use a spacer. For blepharoplasty it is mandatory to distinguish between orbital fat prolapse and subbrow fat pad. A prolapse of the lacrimal gland should not be missed and generally, skin excision performed sparingly.

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Section: Discussionmentioning

confidence: 93%

Eyelid Surgery in Gravesʼ Orbitopathy

Hintschich¹

2021

Klin Monbl Augenheilkd

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“…Numerous surgical techniques to treat TED-related UER have been described, aiming to obtain predictable and satisfactory postoperative eyelid contour and height, including full-thickness blepharotomy, Mueller's muscle recession or excision, anterior or posterior levator recession with or without adjustable sutures, use of spacer grafts, levator lengthening by marginal myotomy, castellated levator aponeurotomy, orbital septal flap, and medial transposition of the lateral horn of the levator aponeurosis. [ 7 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 ]…”

Section: Upper Eyelid Retractionmentioning

confidence: 99%

Management of eyelid retraction related to thyroid eye disease

Osaki¹,

Osaki²,

Monteiro³

2022

Taiwan J Ophthalmol

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Eyelid retraction related to thyroid eye disease (TED) is a challenging condition. It is one of the main clinical signs and a major diagnostic criterion in TED. This condition may threaten vision due to exposure keratopathy, in addition to its esthetic alterations, which may lead to psychosocial implications and affect the patient's quality of life. Although it is more commonly observed in the upper eyelid, it may be present on both the upper and lower lids. Numerous surgical and nonsurgical treatment modalities have been described and will be reviewed in this article. Management should be based on an individual patient assessment, taking into consideration the disease stage, severity, and clinician experience.

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“…To correct upper eyelid retraction, several surgical procedures have been described. These comprise internal or external approach Müllerectomy, with or without graded levator muscle disinsertion, the use of hangback sutures, scleral interposition and full‐thickness eyelid transection (blepharotomy) (Harvey & Anderson 1981; Putterman 1981; Putterman & Fett 1986; Harvey et al 1991; McNab et al, 2004; Elner et al 2004; Ben Simon et al 2005; Hintschich & Haritoglou 2005; Shortt et al, 2011; Nimitwongsakul et al 2013). Reported reoperation rates vary from 8.4% to 23% of eyelids (Golan et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Results of surgical correction of upper eyelid retraction in Graves’ Orbitopathy

Pinas

Keizer

Wubbels

et al. 2020

Acta Ophthalmologica

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Introduction Anterior levator disinsertion/reinsertion and Müllerectomy (ALDM) is generally performed to correct upper eyelid retraction in patients with Graves’ orbitopathy (GO). We studied the outcome of this procedure and its correlation with clinical parameters. Patients and Methods Retrospective analysis of results of ALDM in 305 consecutive euthyroid patients with burnt‐out GO treated in our hospital between 1 January 2000 and 1 January 2016. From the patient files, we recorded data on age, gender, laterality of surgery, smoking history and previous interventions. For outcome analysis, we used a qualitative scoring system with subdivision into three categories (good (MRD‐1 of 4–5 mm, smooth upper eyelid contour and left‐right difference of < 1 mm); acceptable (MRD‐1 of 3–<4 or> 5–6 mm), smooth upper eyelid contour and left‐right difference of < 2 mm; poor: if none of the above criteria was met). We analysed the outcome per eyelid as well as per patient. Results Of the 305 patients (471 eyelids), 166 underwent bilateral and 139 unilateral surgery. Regarding eyelids, the outcome of surgery was good in 71.6% (337/471) acceptable in 15.7% (74/471) and poor in 12.7% (60/471). Regarding patients, the outcome was good in 64.3% (196/305), acceptable in 15.7% (48/305) and poor in 20% (61/305). Concerning bilateral and unilateral surgery, the outcome was good in 60.8% (101/166) and acceptable in 16.9% (28/166) of patients after bilateral surgery, and good in 68.3% (95/139) and acceptable in 14.4% (20/139) of the patients after unilateral surgery (p = 0.17). Reoperation was performed in 16% (75 of 471) of eyelids and in 22 % (66 of 305) of patients. After secondary surgery, the cumulative success percentage was good in 78.6% (370/471) of eyelids and in 79% (241/305) of patients. We found no relation between surgical outcome and any other studied parameter, such as age, gender, smoking history and previous intervention such as extraocular muscle surgery and/or orbital decompression. Conclusion Correction of upper eyelid retraction yields a good result in 64.3% of patients and 71.6% of eyelids. With one additional procedure, the procedure proved was successful in 79% of patients and eyelids. We found no relation between the outcome of surgery and any other parameter, such as previous disease severity, previous interventions or smoking history. For comparative analysis, we recommend to report the outcome per patient rather than per eyelid.

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Modified Full-Thickness Blepharotomy for Treatment of Thyroid Eye Disease

Abstract: Our surgical approach can be performed efficiently and produces predictably satisfactory eyelid height even in severely retracted eyelids.

Cited by 13 publications

References 17 publications

Eyelid Surgery in Gravesʼ Orbitopathy

Eyelid Surgery in Gravesʼ Orbitopathy

Management of eyelid retraction related to thyroid eye disease

Results of surgical correction of upper eyelid retraction in Graves’ Orbitopathy

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