Lee Nahyoung Grace, Habib Larissa, Hall Jonathan, Freitag Suzanne K
a Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
b Department of Ophthalmology , MVZ Prof. Neuhann , Munich , Germany.
Orbit. 2019 Apr;38(2):124-129. doi: 10.1080/01676830.2018.1474237. Epub 2018 May 9.
To report a simple, highly effective technique of simultaneous transconjunctival repair of upper and lower eyelid retraction in patients with thyroid eye disease (TED).
A retrospective interventional case review was conducted on 22 eyes of 19 TED patients. The lower eyelid was recessed with placement of a tarsoconjunctival spacer graft harvested from the upper eyelid. The upper eyelid was then recessed through the conjunctival incision used to harvest the tarsal graft. A temporary tarsorrhaphy was placed for 5-7 days. The postoperative outcome was assessed by measuring the margin reflex distance of the upper eyelid (MRD1), inferior scleral show (ISS), and lagophthalmos.
The absolute change in MRD1 ranged from 0 to 5 mm with an average of 1.86 ± 1.34 mm. The absolute change in ISS ranged from 0 to 2 mm with an average of 1.3 ± 0.49 mm. One patient had postoperative lagophthalmos and 17 of 19 had improvement in their ocular surface exposure symptoms. None of the patients' grafts were observed to undergo absorption during the postoperative course.
This technique of harvesting a free tarsoconjunctival graft from the upper eyelid as a posterior spacer for the lower while simultaneously recessing the upper eyelid through the same incision is an effective and durable method of correcting eyelid retraction in TED.
报告一种用于甲状腺眼病（TED）患者上下眼睑退缩同时经结膜修复的简单、高效技术。
对19例TED患者的22只眼进行回顾性介入病例分析。通过植入取自上睑的睑板结膜间隔移植物使下睑后退。然后通过用于获取睑板移植物的结膜切口使上睑后退。放置临时睑缘缝合术5 - 7天。通过测量上睑缘反射距离（MRD1）、下方巩膜暴露（ISS）和兔眼来评估术后结果。
MRD1的绝对变化范围为0至5毫米，平均为1.86±1.34毫米。ISS的绝对变化范围为0至2毫米，平均为1.3±0.49毫米。1例患者术后出现兔眼，19例中有17例眼表暴露症状改善。术后过程中未观察到患者的移植物发生吸收。
这种从上睑获取游离睑板结膜移植物作为下睑后间隔同时通过相同切口使上睑后退的技术是纠正TED患者眼睑退缩的一种有效且持久的方法。
