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Optimizing esthetic outcomes in graded full-thickness anterior blepharotomy for Graves’ ophthalmopathy

  • Jason Kian Seng Lee
  • Mei-Xue Loi
  • Yi-Hsuan Wei
  • Shu-Lang LiaoEmail author
Oculoplastics and Orbit
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Abstract

Purpose

Current outcome measures do not adequately address the esthetic aspect of the surgical outcome of anterior blepharotomy for Graves’ ophthalmopathy. This study aims to highlight the role of tarsal platform show (TPS) in optimizing the esthetic outcome of graded full-thickness anterior blepharotomy for dysthyroid upper eyelid retraction in an ethnic Chinese population.

Methods

The records of patients with Graves’ ophthalmopathy who underwent anterior blepharotomy for upper eyelid retraction over a period of 30 months were retrospectively reviewed.

Results

Fifty-five patients (77 eyelids) with upper eyelid retraction underwent anterior blepharotomy. A statistically significant decrease in marginal reflex distance (MRD1) and lagophthalmos and significant increase in TPS following anterior blepharotomy was observed. A significantly higher proportion of patients who underwent unilateral anterior blepharotomy had TPS asymmetry post-operatively as compared to the bilateral group (p < 0.001). Using logistic regression, the study found that for every 1-mm change in MRD1, there was approximately a 1.045-mm change in TPS. The mean percentage increase in TPS observed in our study was 303.1 ± 191% due to the low pre-operative TPS seen in Asian patients.

Conclusions

To achieve the most ideal surgical outcome in graded full-thickness anterior blepharotomy, the surgeon will need to consider not only eyelid height but also the subsequent TPS change. The surgeon needs to be mindful of the relationship between MRD1 change and TPS change to optimize esthetic outcome as well as symmetry. Special considerations need to be taken in unilateral cases as well as patients with low pre-operative TPS.

Keywords

Esthetic outcome Anterior blepharotomy Upper eyelid retraction Tarsal platform show Graves’ ophthalmopathy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial disclosure

The authors have no financial or proprietary interest in any materials or methods mentioned in this article.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jason Kian Seng Lee
    • 1
  • Mei-Xue Loi
    • 2
  • Yi-Hsuan Wei
    • 3
  • Shu-Lang Liao
    • 3
    • 4
    Email author
  1. 1.Ophthalmology and Visual Sciences DepartmentKhoo Teck Puat HospitalSingaporeSingapore
  2. 2.Department of OphthalmologyTaipei Medical University Wan Fang HospitalTaipeiTaiwan
  3. 3.Department of OphthalmologyNational Taiwan University HospitalTaipeiTaiwan
  4. 4.School of MedicineNational Taiwan UniversityTaipeiTaiwan

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