Nowak-Gospodarowicz Izabela, Rękas Marek
Department of Ophthalmology, Military Institute of Medicine, 04-141 Warsaw, Poland.
J Clin Med. 2021 Feb 4;10(4):578. doi: 10.3390/jcm10040578.
Implantation of gold weights into the upper eyelid is a proven method of treating lagophthalmos and exposure keratopathy in patients with unresolved facial nerve palsy. The aim of this study was to evaluate the factors affecting visual acuity and corneal complications in patients after upper eyelid gold weight lid loading.
This prospective consecutive clinical study was conducted in years 2012-2018. In total, 59 people (40 women, 19 men aged 55.5 ± 17.4 years) meeting the inclusion criteria were treated with gold weights. The ordered multinomial logit model was used to analyze the factors affecting best-corrected visual acuity (BCVA) and degree of exposure keratopathy after surgery. The influence of the following variables was analyzed: patient age, etiology and duration of the facial nerve palsy, history of the previous eyelid surgery, degree of lagophthalmos in mm, presence of Bell's phenomenon, and corneal sensation, Schirmer test results.
Implantation of gold weights into the upper eyelid effectively reduced lagophthalmos and exposure keratopathy in the study group ( < 0.001). BCVA was maintained or better in 95% of patients after surgery. Patient age, presence of the Bell's phenomenon, and corneal sensation significantly affected the final BCVA ( < 0.1). The presence of Bell's phenomenon and corneal sensation had a positive effect on the degree of keratopathy after surgery ( < 0.1). In turn, patient age and history of tarsorrhaphy were significant negative prognostic factors of exposure keratopathy and BCVA after surgery ( < 0.05). Etiology and duration of facial nerve palsy, degree of corneal exposure in mm, and results of the Schirmer test did not have a significant impact on the outcome after surgery ( > 0.1).
The results of our study may help to answer the question of how to direct ophthalmologists and other specialists who refer to ophthalmologists for management advice in patients with facial nerve palsy. Elderly patients with a history of tarsorrhaphy who present with poor Bell's phenomenon and/or a lack of corneal sensation should be the first candidates for immediate correction of lagophthalmos.
在上睑植入金片是治疗面神经麻痹未愈患者兔眼和暴露性角膜病变的一种经证实的方法。本研究的目的是评估上睑金片植入术后影响患者视力和角膜并发症的因素。
这项前瞻性连续临床研究于2012年至2018年进行。共有59名符合纳入标准的患者（40名女性，19名男性，年龄55.5±17.4岁）接受了金片植入治疗。采用有序多项logit模型分析术后影响最佳矫正视力（BCVA）和暴露性角膜病变程度的因素。分析了以下变量的影响：患者年龄、面神经麻痹的病因和持续时间、既往眼睑手术史、兔眼程度（以毫米为单位）、贝尔现象的存在情况以及角膜感觉、泪液分泌试验结果。
在上睑植入金片有效减轻了研究组的兔眼和暴露性角膜病变（<0.001）。95%的患者术后BCVA得以维持或改善。患者年龄、贝尔现象的存在情况以及角膜感觉对最终BCVA有显著影响（<0.1）。贝尔现象的存在和角膜感觉对术后角膜病变程度有积极影响（<0.1）。相反，患者年龄和睑裂缝合术史是术后暴露性角膜病变和BCVA的显著负性预后因素（<0.05）。面神经麻痹的病因和持续时间、角膜暴露程度（以毫米为单位）以及泪液分泌试验结果对术后结局无显著影响（>0.1）。
我们的研究结果可能有助于回答如何指导眼科医生以及其他向眼科医生寻求面神经麻痹患者管理建议转诊的专科医生的问题。有睑裂缝合术史、贝尔现象不佳和/或缺乏角膜感觉的老年患者应是立即矫正兔眼的首批候选者。
