Correction of Lower Eyelid Retraction Using Acellular Human Dermis During Orbital Decompression

Area of Science:

• Ophthalmology
• Plastic Surgery
• Regenerative Medicine

Background:

• Graves' orbitopathy frequently causes lower eyelid retraction, impacting ocular health and appearance.
• Swinging eyelid orbital decompression is a common surgical approach for severe cases.
• Correction of lower eyelid retraction is crucial for optimal surgical outcomes.

Purpose of the Study:

• To compare the efficacy of acellular human dermis (AHD) grafting versus inferior retractor recession for correcting lower eyelid retraction during swinging eyelid orbital decompression.
• To evaluate surgical outcomes including lower eyelid height, scleral show, and cosmetic appearance.

Main Methods:

• A retrospective study of 54 patients with Graves' orbitopathy (95 eyes) undergoing orbital decompression.
• Patients were divided into three groups: AHD grafting (Group 1), inferior retractor recession (Group 2), and decompression only (Group 3).
• Outcomes were assessed by measuring lower eyelid height, inferior scleral show, and cosmetic appearance post-surgery.

Main Results:

• No significant differences in baseline characteristics or exophthalmos improvement were observed between groups.
• Group 1 (AHD grafting) showed significantly greater improvement in MRD2 (marginal reflex distance 2) and reduction in inferior scleral show compared to Groups 2 and 3.
• Postoperative improvements in lower eyelid retraction were significantly higher in the AHD group at 4-6 months.

Conclusions:

• Simultaneous correction of lower eyelid retraction with thin AHD during swinging eyelid orbital decompression provides superior outcomes.
• Acellular human dermis grafting is an effective method for maximizing lower eyelid retraction correction in Graves' orbitopathy.
• This technique offers a significant advantage over concurrent inferior retractor recession.