Department of Ophthalmology, Jules Stein Eye Institute, Division of Orbital and Oculoplastic Surgery, University of California Los Angeles, Los Angeles, California 90095, USA.
Ophthalmic Plast Reconstr Surg. 2012 Nov-Dec;28(6):419-23. doi: 10.1097/IOP.0b013e318263c56e.
Classically, the aesthetic outcomes of eyelid retraction surgery in patients with thyroid-associated orbitopathy have been described in reference to eyelid margin position and marginal reflex distance. A critically important component of upper eyelid contour is the tarsal platform show (TPS). With this study, the authors aimed to assess the hypothesis that modification of the tarsal platform in posterior eyelid retraction surgery has a significant effect on the final aesthetic outcome.
In a retrospective, observational, case-cohort study, the authors reviewed the medical records of 36 patients with thyroid-associated orbitopathy who underwent primary eyelid retraction surgery by 1 surgeon. Patients who underwent eyelid retraction surgery at the time of orbital decompression were excluded. The surgical technique consisted of posterior approach conjunctival release of Müeller muscle and graded recession of the levator aponeurosis. To address lateral flare, dissection was carried toward the lateral orbital rim with spreading of the lateral horn of the levator aponeurosis. Outcome measures were millimeters of TPS, millimeters of brow fat span, and symmetry of the eyelid margin position. Randomized preoperative and postoperative standardized photographs were evaluated in masked fashion by 4 surgeons to grade cosmetic outcomes.
Fifteen patients (24 eyelids) met the inclusion criteria. Mean follow-up period was 6 months (range, 3-12). Mean TPS increased from 2.27 mm (standard deviation, 1.9 mm) to 4.77 mm (standard deviation, 1.7 mm; p < 0.05). Mean brow fat span remained unchanged, from 13.22 mm (standard deviation, 2.2 mm) to 13.25 mm (standard deviation, 1.9; p > 0.05). Evaluation of the aesthetic outcomes (eyelid contour, eyelid symmetry, and TPS) by 4 masked observers characterized the relevance of TPS in the postoperative aesthetics of eyelid contour and symmetry.
In upper eyelid retraction surgery, the ability to control the TPS has a significant impact on the final aesthetic outcome. Posterior approach eyelid retraction surgery can control eyelid contour and can represent an ideal surgical approach in carefully selected patients. However, it has limited ability to control upper orbital volume and eyebrow and orbital fat (brow fat span). This can result in relative overelongation of the TPS. Factors such as ethnic characteristics, bony asymmetry, brow fat span, and premorbid TPS influence cosmetic outcomes achieved by the anterior or posterior approach. For optimal aesthetic results in eyelid retraction surgery, the decision for anterior versus posterior approach should be individualized.
在甲状腺相关眼病患者的眼睑退缩手术中，通常根据眼睑缘位置和边缘反射距离来描述美学效果。上眼睑轮廓的一个非常重要的组成部分是睑板平台显露（TPS）。通过这项研究，作者旨在评估假设，即在后部眼睑退缩手术中修改睑板平台对最终美学效果有显著影响。
在一项回顾性、观察性、病例对照研究中，作者回顾了 36 例由同一位外科医生行原发性眼睑退缩手术的甲状腺相关眼病患者的病历。排除了在眼眶减压时行眼睑退缩手术的患者。手术技术包括后部结膜切开术松解 Müller 肌和提上睑肌腱膜分级后退。为了解决外侧外展问题，向外侧眶缘进行解剖，并展开提上睑肌的外侧角。测量指标包括 TPS 毫米数、眉脂肪跨度和眼睑缘位置的对称性。由 4 名外科医生以盲法评估随机术前和术后标准化照片，以分级美容效果。
15 名患者（24 只眼）符合纳入标准。平均随访时间为 6 个月（范围，3-12 个月）。TPS 平均值从 2.27 毫米（标准差，1.9 毫米）增加到 4.77 毫米（标准差，1.7 毫米；p<0.05）。眉脂肪跨度保持不变，从 13.22 毫米（标准差，2.2 毫米）到 13.25 毫米（标准差，1.9 毫米；p>0.05）。由 4 名盲法观察者评估的美学效果（眼睑轮廓、眼睑对称性和 TPS）表明 TPS 在术后眼睑轮廓和对称性的美学效果中具有重要意义。
在上眼睑退缩手术中，控制 TPS 的能力对最终美学效果有显著影响。后部入路眼睑退缩手术可以控制眼睑轮廓，在精心选择的患者中可以作为理想的手术方法。然而，它对控制上眶容积和眉毛及眶脂肪（眉脂肪跨度）的能力有限。这可能导致 TPS 相对延长。种族特征、骨不对称、眉脂肪跨度和术前 TPS 等因素会影响前部或后部入路的美容效果。为了在眼睑退缩手术中获得最佳美学效果，应根据个体情况决定采用前部入路还是后部入路。
