[A temporal tarsorrhaphy increases the effect of lower lid lengthening in patients with Graves' orbitopathy]

The aim of this study was to compare outcomes of lower lid lengthening with and without an additional temporal tarsorrhaphy.

Lower lid lengthening was performed in 39 patients (16 without tarsorrhaphy [group 1], 23 with tarsorrhaphy [group 2]) via a posterior subtarsal transconjunctival ac-ess. A bovine pericardial transplant (Tutopatch, length = amount of retraction + 4 mm) was placed between the recessed retractors and the tarsus.

Mean preoperative lower lid retraction was 2.3 mm in group 1 and 2.6 mm in group 2 (n. s.). Lower lid lengthening and simultaneous tarsorrhaphy resulted in significantly increased reduction of lower lid retraction: 2.3 mm (1.5 - 4.5) (p = 0.003) compared to patients without tarsorrhaphy: 1.4 mm (0 - 3.0). Patients with tarsorrhaphy presented a higher success rate concerning the elimination of lagophthalmos (success = lagophthalmos ≤ 0.5 mm: 21 / 23 (91.3 %) as opposed to patients without tarsorrhaphy: 8 / 16 (50 %); (p = 0.004). Scleral show was eliminated in 78 % of group 2 in comparison to only 50 % in group 1 (p = 0.06).

Lower lid lengthening should be combined with simultaneous temporal tarsorrhaphy in patients with lower lid retraction exceeding 1.5 mm. The tarsorrhaphy increases the effect of lower lid lengthening by about 1 mm.