Abstract

DO.19.06

Autogenous tarsus transplant as spacer for treatment of lower lid retraction in Grave’s disease

Schittkowski M. P., Fichter N., Guthoff R. F.
University Eye Department Rostock, Rostock

Objective: Lower lid retraction in dysthyroid orbitopathy is of less functional concern than optic neuropathy or diplopia in central positions of gaze. But it may lead to incomplete lid closure resulting in corneal exposure. Patients often suffer from aesthetical impairment.
Methods: Retrospective analysis of 10 consecutive patients treated for lower lid retraction due to Graves Disease between 2005 and 2007. Despite a regular ophthalmological examination specific attention was called to measurement of lid fissure width and scleral show for quantification of lower lid retraction. Operation: The lower lid is everted and the conjunctiva is openened horizontally under the tarsal edge. Lower lid retractors are disinserted and dissected until the lower lid might be elevated in symmetry to the fellow eye. This procedure is continued until 1mm overcorrection is gained. The resulting defect is measured and a tarsal transplant of this size is harvested from the ipsilateral upper lid tarsus. At least 4mm vertical tarsus have to be left. Tarsus is sutured with absorbable material.
Results: In the 10 patients operated (7 women, 3 men) aged 23-61 years scleral show was preoperative 2.7mm (mean) and postoperative 0.3mm. Lid fissure width was preoperative 12.8mm (11-16mm) and immediately postoperative 10.2mm (8.8-12.2). 6 months postoperative the lid-elevating effect was reduced by 0.5mm in average in the 7 patients available for control.
Conclusions: Using this particular technique functional and aesthetical satisfying results are received. Main advantages are renunciation of allogen, xenogeny or synthetic material with its possible risks of slow-virus-infection and/or extrusion.

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