Ottonelli Giovanni, Celada Ballanti Jacopo, Gaeta Alessandro, Barone Gianmaria, Montericcio Novella, Di Maria Alessandra
Department of Ophthalmology, Humanitas University, Pieve Emanuele, 20090 Milan, Italy.
Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 16132 Genova, Italy.
J Clin Med. 2025 Jul 2;14(13):4688. doi: 10.3390/jcm14134688.
: Incomplete eyelid closure and lagophthalmos due to facial nerve palsy are significant functional and aesthetic concerns often requiring surgical correction. The aim of this systematic review is to quantitatively assess the efficacy, safety, and patient satisfaction associated with gold or platinum weight implantation, autologous fat grafting (lipofilling), and müllerectomy. : A systematic review was performed following PRISMA guidelines, searching PubMed, Embase, Cochrane Library, Web of Science, and Scopus up to March 2025. Studies included clinical data on surgical correction for incomplete eyelid closure in facial palsy, reporting functional, anatomical, and satisfaction outcomes. Quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. : Twenty-six studies including a total of 1205 patients were included. Gold/platinum weight implantation achieved complete or near-complete eyelid closure in 83-92% of cases, with a reduction in lagophthalmos to <1 mm. Complication rates ranged from 5-15% (mainly extrusion/migration), and patient satisfaction averaged 7.9/10. Lipofilling showed persistent benefit in 77% of cases, with 9-20% requiring repeat procedures and 10-12% experiencing minor complications. Müllerectomy yielded symptomatic improvement or resolution in 92% of cases, with a mean lagophthalmos reduction of 1.18 mm. : Gold or platinum weight implantation provides the most reliable improvement for severe upper eyelid dysfunction in facial palsy. Lipofilling is a viable autologous alternative, while müllerectomy is effective in selected cases. Further prospective comparative trials are needed to refine surgical selection and optimize outcomes.
由于面神经麻痹导致的眼睑闭合不全和兔眼症是严重的功能和美观问题，通常需要手术矫正。本系统评价的目的是定量评估与金或铂重物植入、自体脂肪移植（脂肪填充）和睑板肌切除术相关的疗效、安全性和患者满意度。
按照PRISMA指南进行了系统评价，检索了截至2025年3月的PubMed、Embase、Cochrane图书馆、Web of Science和Scopus。纳入的研究包括面神经麻痹导致眼睑闭合不全的手术矫正临床数据，报告功能、解剖学和满意度结果。使用纽卡斯尔-渥太华量表（NOS）和推荐分级评估、制定与评价（GRADE）系统评估质量。
纳入了26项研究，共1205例患者。金/铂重物植入在83%-92%的病例中实现了完全或接近完全的眼睑闭合，兔眼症减少至<1mm。并发症发生率为5%-15%（主要是挤出/移位），患者满意度平均为7.9/10。脂肪填充在77%的病例中显示出持续益处，9%-20%需要重复手术，10%-12%出现轻微并发症。睑板肌切除术在92%的病例中产生了症状改善或缓解，平均兔眼症减少1.18mm。
金或铂重物植入为面神经麻痹导致的严重上睑功能障碍提供了最可靠的改善。脂肪填充是一种可行的自体替代方法，而睑板肌切除术在特定病例中有效。需要进一步的前瞻性比较试验来优化手术选择并改善结果。
