Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.
Center for Clinical Research, Haukeland University Hospital, Bergen, Norway; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
J Plast Reconstr Aesthet Surg. 2019 Jun;72(6):973-981. doi: 10.1016/j.bjps.2018.12.031. Epub 2018 Dec 14.
To compare injections of hyaluronic acid (HA) and autologous fat (AF) for the treatment of unsightly temporal hollowing after lateral orbital wall decompression in thyroid eye disease.
In this nonblinded prospective comparative interventional study, patients received injections of HA in the right temple and AF in the left temple. Additional injections were given when needed at follow-up after 6, 12, 18, and 24 months. Follow-up included an interview; clinical examination with an evaluation of symmetry, contour, and skin surface; and ultrasound measurements. From photographs, the temporal hollowing was graded 1-3. The main endpoints were grading of temporal hollowing and temporal soft tissue thickness.
Seventeen patients were treated bilaterally and 12 unilaterally (five received HA and seven AF). Injection(s) of HA and AF administered at each site were a median (range) of 1 (1-4) and 2 (1-5), respectively. The total combined volume of HA injected per site was 0.9 (0.2-2.0) ml and that of AF was 3.1 (0.5-9.6) ml. At the final examination, a statistically significant difference in mean (SD) grading scores of temporal hollowing due to HA (1.18 (0.26)) compared to those of AF (1.85 (0.44)) was observed (p < 0.001). Six months after administering an injection of HA, the temporal soft tissue thickness was 2.35 (0.24) cm compared to 2.19 (0.28) cm obtained with an injection of AF (p < 0.001). By using a linear mixed-effect model and adjusting for baseline values, age, sex, and refill, the difference in favor of HA persisted at all later follow-ups. Increased fibrosis of the subcutaneous tissue developed at 5/24 sites that received AF.
Injection of HA is superior to that of AF for treating temporal hollowing after lateral orbital wall decompression.
比较透明质酸（HA）和自体脂肪（AF）注射治疗甲状腺相关眼病外侧眶壁减压术后难看的颞部凹陷。
在这项非盲前瞻性对照干预研究中，患者右侧颞部接受 HA 注射，左侧颞部接受 AF 注射。如果需要，在 6、12、18 和 24 个月后的随访中进行额外的注射。随访包括访谈、临床检查评估对称性、轮廓和皮肤表面，并进行超声测量。根据照片，颞部凹陷分级为 1-3 级。主要终点是颞部凹陷和颞部软组织厚度的分级。
17 名患者双侧接受治疗，12 名患者单侧接受治疗（5 名接受 HA，7 名接受 AF）。HA 和 AF 分别在每个部位注射的中位数（范围）为 1（1-4）和 2（1-5）。每个部位注射的 HA 总量为 0.9（0.2-2.0）ml，AF 为 3.1（0.5-9.6）ml。在最后一次检查时，HA（1.18（0.26））与 AF（1.85（0.44））相比，颞部凹陷的平均（SD）评分有统计学显著差异（p<0.001）。HA 注射后 6 个月，颞部软组织厚度为 2.35（0.24）cm，而 AF 注射后为 2.19（0.28）cm（p<0.001）。使用线性混合效应模型，并根据基线值、年龄、性别和填充进行调整，HA 始终优于 AF。24 个接受 AF 注射的部位中有 5 个出现皮下组织纤维化增加。
与 AF 相比，HA 注射治疗外侧眶壁减压术后颞部凹陷效果更好。
