Document Detail


Correction of lower eyelid retraction in thyroid eye disease: a randomised controlled trial of retractor tenotomy with adjuvant antimetabolite versus scleral graft.
MedLine Citation:
PMID:  9613385     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/AIMS: Lower eyelid retraction in thyroid eye disease contributes to ocular discomfort and an unsightly appearance, especially if asymmetrical. The use of donor scleral grafts is effective in lengthening the lower eyelids but carries a risk of virus transmission. Other techniques, including those which do not use grafts, need to be compared with scleral grafts. Recurrent retraction is a recognised complication of thyroid eyelid surgery; therefore, the authors investigated the use of antimetabolites to reduce postoperative fibrosis. METHODS: In this prospective randomised controlled trial of 25 patients (35 eyelids), the use of donor sclera in 20 lower eyelids (13 patients) was compared with partial tenotomy of the anterior part of the lower eyelid retractors (ALER) with adjuvant peroperative antimetabolite in 15 lower eyelids (12 patients). A 5 minute peroperative application of either 5-fluorouracil (25 mg/ml) in nine lower eyelids (eight patients) or mitomycin C (0.2 mg/ml) in six lower eyelids (four patients) was used to focally inhibit fibroblasts. Follow up ranged from 3 to 18 months (mean 7.8). RESULTS: One month after surgery the results of both groups were similar. However, at 3 months after surgery the results of scleral grafting were better than tenotomy with antimetabolites: 3/12 patients (25%) treated with tenotomy and adjuvant antimetabolite required subsequent surgery using grafts for correction of recurrent retraction. There were no significant complications associated with the use of antimetabolites in the eyelid in the doses used in this study. CONCLUSIONS: This randomised prospective trial shows that donor scleral grafts were more effective in the long term than partial tenotomy with adjuvant antimetabolite in the correction of lower eyelid retraction associated with thyroid eye disease. The use of peroperative antimetabolites in the lower eyelid was safe.
Authors:
J M Olver; G E Rose; P T Khaw; J R Collin
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of ophthalmology     Volume:  82     ISSN:  0007-1161     ISO Abbreviation:  Br J Ophthalmol     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-06-11     Completed Date:  1998-06-11     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0421041     Medline TA:  Br J Ophthalmol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  174-80     Citation Subset:  IM    
Affiliation:
Moorfields Eye Hospital, London.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antimetabolites / therapeutic use*
Eyelid Diseases / complications,  surgery*
Female
Fluorouracil / therapeutic use*
Humans
Male
Middle Aged
Mitomycin / therapeutic use*
Oculomotor Muscles / surgery*
Postoperative Complications / prevention & control*
Prospective Studies
Sclera / transplantation*
Thyroid Diseases / complications
Chemical
Reg. No./Substance:
0/Antimetabolites; 50-07-7/Mitomycin; 51-21-8/Fluorouracil
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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