A Comparative Prospective Study of Dermis vs. Auricular Cartilage Grafts for the Surgical Correction of Lower Eyelid Retraction in Thyroid Eye Disease.
Author: Allan Pieroni-Goncalves
Base Hospital / Institution: University of Sao Paulo Medical school
Rapid fire oral presentation
Abstract ID: 25-374
Purpose
To compare the efficacy of autologous dermis and auricular cartilage grafts in treating Lower Eyelid Retraction (LER) of Thyroid eye disease patients, with primary focus on changes in Margin Reflex Distance 2 (MRD2).
Methods
This prospective, randomized interventional study included 20 patients with stable TED and LER. Patients were randomly assigned to receive either auricular cartilage or dermis grafts in surgical correction, using a 2mm graft:1mm scleral show ratio. All procedures were performed by a single oculoplastic surgeon at a single institution. Data collected included measurements of lower eyelid retraction using MRD2 from pre- and at 7 days, one month, three months, and six months’ postoperative photographs, with complications and outcomes recorded.
Results
The study included 30 eyelids from 17 patients, split between the two graft groups. A significant improvement in MRD2 was observed in both groups post-surgery with no significant difference. Group 1 (cartilage) showed a 11% MRD2 increase over six months, while Group 2 (dermis) showed an 14% increment. Complication rates were low, with five eyelids in the cartilage group developing granulomas. No persistent keratopathy or infection was noted. Dermis grafts exhibited no cysts or contour issues. Patients with preoperative severe LER (MRD2≥ 8.5mm) showed a 3.01 Relative risk of a poor outcome (MRD2> 7mm) [RR (IC95%) = 3.01 (0.91; 9.89)].
Conclusion
Both graft types were effective for LER treatment, with dermis grafts showing fewer complications and quicker recovery. Applying a 2:1 graft: scleral show rate in both groups we found that a small degree of eyelid retraction persisted in most patient’s post-surgery. This indicates a need to reassess the calculations for graft height, possibly recommending a size slightly greater than twice the scleral show measurement, particularly in severe cases. Additional techniques like midface elevation could improve results. Further research with a larger sample size is warranted to confirm these findings.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Mariana | Dias Gumiero | University of Sao Paulo Medical school |
