Abstract
Purpose
To describe the results of posterior conjunctival plication for the treatment of secondary eyelid ptosis after eyelid retraction repair in Graves disease.
Methods
Case series. All patients were evaluated preoperatively by routine eye examination and eyelid measurements including Margin Reflex Distance 1 and levator function. Two eyes of 2 patients who presented with ptosis following eyelid retraction repair were corrected with posterior conjunctival plication.
Results
Posterior conjunctival plication for secondary ptosis following eyelid retraction repair was successful in 2 eyelids of 2 patients with Graves disease. Follow up period ranged from 6–10 months over which no sign of recurrent ptosis was observed.
Conclusions
Posterior conjunctival plication is an effective surgical technique for the correction of secondary ptosis following eyelid retraction repair in patients with Graves disease.
1
Introduction
Upper eyelid retraction is a common manifestation of Graves orbitopathy. Different surgical procedures have been described for correction of upper eyelid retraction . These include levator muscle procedures such as levator recession alone, levator recession with adjustable sutures or spacer grafts , and marginal myotomy. Graded full-thickness anterior blepharotomy has also been described, as well as Muller muscle recession or excision . The challenge is to obtain the desired amount of recession without over-correction resulting in secondary ptosis and unwanted eyelid contour changes . The purpose of this case series is to present two patients who successfully underwent a posterior conjunctival plication procedure to correct secondary ptosis following upper eyelid retraction repair for Graves disease.
2
Methods
Two patients with unilateral secondary ptosis after eyelid retraction repair were evaluated at a secondary referral, outpatient clinic. Eyelid measurements were performed including Margin Reflex Distance 1 (MRD1) and levator function. MRD1 measurements of the affected eyelids were taken preoperatively, postoperatively, and after secondary revision.
2
Methods
Two patients with unilateral secondary ptosis after eyelid retraction repair were evaluated at a secondary referral, outpatient clinic. Eyelid measurements were performed including Margin Reflex Distance 1 (MRD1) and levator function. MRD1 measurements of the affected eyelids were taken preoperatively, postoperatively, and after secondary revision.
3
Surgical technique
Initially, the patients had eyelid retraction with an MRD1 of 6 and 8 mm ( Fig. 1 ). An eyelid retraction repair was performed. An eyelid crease incision is marked and incised with a #15 blade. Sharp dissection is performed in the preseptal plane and an orbicularis oculi flap is everted inferiorly. The levator muscle is identified at the superior border of the tarsus. The fibers of the levator muscle and Muller muscle are then recessed with intraoperative adjustment of height and contour leaving bare conjunctiva ( Fig. 2 ). The upper eyelid is then closed with a running 6–0 Prolene (Ethicon, New Jersey, USA) suture.
