Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Ophthalmic Plast Reconstr Surg. 2024;40(5):516-522. doi: 10.1097/IOP.0000000000002632. Epub 2024 Apr 15.
To compare outcome, complications and surgical time of blepharotomy versus levator recession with adjustable sutures (LRWAS) for correction of upper eyelid retraction in thyroid eye disease.
In the period 2019-2023, we performed a prospective randomized comparative study between blepharotomy and LRWAS. We examined patients, recorded time consumption, and obtained photographs preoperatively, 1 day, 1 week, 3 months, and 6 months after surgery. Outcome was categorized according to Mourits and Sasim`s classification from 1999 (perfect-acceptable-unacceptable).
A total of 30 patients (25 women) with a median (range) age of 51.5 (34-74) years at surgery were included. A significant different ( p < 0.01) median operation time was found between blepharotomy (41.5 (17-105) minutes) and LRWAS (68 (35-101) minutes). Median time from operation to last examination was 6 (6-18) months. Fifteen patients (24 eyelids) were operated with blepharotomy and 15 patients (25 eyelids) with LRWAS. Preoperative median margin reflex distance 1 was 6.5 (5-8) mm, and at final visit, median margin reflex distance 1 was 3.5 (3-4) mm after blepharotomy and 3.5 (2-5.5) mm after LRWAS. Reoperation was performed in 11 eyelids, 10 due to overcorrection and 1 because of a residual retraction. Significantly more eyelids needed reoperation after LRWAS (n = 9) compared with blepharotomy (n = 2). At final examination, a perfect or acceptable result was found in 14 (93%) patients after both procedures. Significantly shorter total duration of all visits was observed after treatment with blepharotomy (50 (35-70) minutes) compared with LRWAS (65 (40-115) minutes). Wound dehiscence occurred in 1 patient after blepharotomy, and 1 postoperative infection was observed after LRWAS.
We demonstrate equally high success rates after blepharotomy and LRWAS for correcting upper eyelid retraction in thyroid eye disease, but blepharotomy is less time-consuming and implies fewer reoperations.
比较睑切开术与可调节缝线提上睑肌缩短术（LRWAS）治疗甲状腺相关眼病的上睑退缩的结果、并发症和手术时间。
在 2019 年至 2023 年期间，我们进行了一项前瞻性随机对照研究，比较了睑切开术与 LRWAS。我们检查了患者，记录了时间消耗，并在术前、术后 1 天、1 周、3 个月和 6 个月拍摄了照片。结果根据 Mourits 和 Sasim 1999 年的分类（完美-可接受-不可接受）进行分类。
共纳入 30 例（25 例女性）患者，手术时的中位（范围）年龄为 51.5（34-74）岁。睑切开术（41.5（17-105）分钟）和 LRWAS（68（35-101）分钟）的中位手术时间存在显著差异（p<0.01）。从手术到最后一次检查的中位时间为 6（6-18）个月。15 例（24 只眼）行睑切开术，15 例（25 只眼）行 LRWAS。术前平均 MRF 1 为 6.5（5-8）mm，末次随访时，MRF 1 平均为 3.5（3-4）mm，睑切开术后为 3.5（2-5.5）mm。LRWAS 后 11 只眼（9 只眼）因过矫需要再次手术，1 只眼因残留退缩需要再次手术。LRWAS 组（n=9）需要再次手术的眼数明显多于睑切开术组（n=2）。两种方法的最终检查均发现 14 例（93%）患者的结果为完美或可接受。与 LRWAS 相比（50（35-70）分钟），睑切开术（40-115）分钟）的所有就诊时间总持续时间明显更短。1 例患者在睑切开术后出现伤口裂开，1 例患者在 LRWAS 术后出现感染。
我们证明了睑切开术和 LRWAS 治疗甲状腺相关眼病的上睑退缩同样具有较高的成功率，但睑切开术耗时更少，需要再次手术的次数更少。
