The role of gold weight implants in the management of paralytic lagophthalmos

Abstract

Background/aim: The study aims to evaluate the usage of gold weight implants and monitor complaints and comfort of patients.Methods: A hundred and ninety-one implantations performed between January 2009 and January 2019 were analyzed. Seventy-eight patients included in this study The average age of the patients was 51.3±14.5 years. Forty-five (57.7%) of them were male and 33 (42.3%) female. Patient satisfaction was measured with a questionnaire containing the most common complaints related to gold weight in the literature through telephone surveys.Results: The average follow-up time was 74,5 months. Ninety-three-point-five percent of subjects had operational causes, among which the most widespread was acoustic neuroma (44.9%). The average time between facial paralysis and implantation was 141,1 days. Implantation was performed 26,6 days on average after acoustic neuroma surgery and 3,2 days on average after temporal zone malignancy surgery. Thirty-eight patients had their implants removed over either complication (n=14) or recovery (n=24).Recovery was the fastest after facial nerve decompression (mean= 4,75±3,6 (2-10) months) and the slowest after 7-12 cranial nerve transfer (mean= 18,3±8,2 (3-31) months). Twenty-six-point-nine percent (n=21) of patients had complications, of which the most common was extrusion (n=10). The overall satisfaction rate was 88,5% with the highest in visual acuity and the lowest in continuous requirement for artificial tear. Conclusions:The gold weight implantation is an effective, reversible, and easy procedure significantly reducing complaints regarding paralytic lagophthalmos. Early implementation may be beneficial for ocular complications. A dynamic facial reanimation could terminate need of implant.

Outcome Comparison of Transconjunctival Müller’s Muscle Recession With Levator Disinsertion (TMRLD) to Gold Weight Implantation in the Treatment of Paralytic Lagophthalmos

“…Although a gold or platinum weight implant on the upper eyelid adds to the gravitational protractor effects upon volitional closure in an upright position throughout the day, the benefit is lost while laying supine to sleep as the implant moves posteriorly, causing retraction of the eyelids and exacerbation of lagophthalmos in up to 4% of the patients. 6,13,14 Elevating the head of the bed and taping the eyelids may address such undesired gravitational effect. 13 We found no reports on nocturnal lagophthalmos after TMRLD surgeries while achieving comparable effects in MRD1, corneal health, and visual acuity to GW.…”

“…19,20 Unlike TMRLD surgeries, gold weight implants had been associated with extrusion rates ranging from 6.8% to 10%. 4,14 A study of 107 consecutive gold implants showed prominent implants (71%), poor lid contour (67%), and persistent erythema (29%). 5 Other complications include implant migration, capsule formation, and induced astigmatism.…”