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Posterior lamellar grafting for eyelid retraction has good long-term results
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In the long term, performing posterior lamellar grafting and lateral eyelid tightening appears effective for correcting lower eyelid retraction, according to 15-year results from a retrospective chart review by researchers in Canada.
James H. Oestreicher, MD, and colleagues at the University of Toronto reviewed outcomes after performing posterior lamellar grafting using either hard plate mucosa, free tarsoconjunctival or free scleral grafts on 659 eyelids of 400 patients to correct lower eyelid elevation. For analysis, the patients were divided into four etiologic groups: thyroid ophthalmopathy, previous surgery, trauma and idiopathic causes.
The investigators compared subjective patient symptoms and objective measurements of lagophthalmos, scleral show and superficial punctate keratopathy between graft types and etiologic groups at baseline and at postoperative intervals that averaged 16.5 months.
The investigators observed a mean reduction of approximately 0.5 mm in lagophthalmos, a mean score reduction of 0.2 (on a scale from 1 to 3) in superficial punctuate keratopathy and a mean scleral show of approximately 1.3 mm in all etiologic groups and graft types.
"Furthermore, 90% of patients subjectively reported a reduction of one to three symptoms," the authors said.
They found that hard palate mucosa grafts were more likely to be used than tarsoconjunctival grafts in cases with one or more previous surgeries (P < .001).
Complications were more common with tarsoconjunctival grafts; however, the difference was statistically significant only for wound dehiscence (P = .004), according to the study, published in the May-June issue of Ophthalmic Plastic and Reconstructive Surgery.