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목적 : To investigate the surgical outcome of lengthening of posterior lamella using spacer graft during swinging eyelid orbital decompression compared to concurrent lower eyelid retractor recession and swinging eyelid orbital decompression for correction of lower lid retraction in patients with Graves’ orbitopathy (GO)
방법 : Medical charts and photographs of all patients undergoing orbital decompression with minimum postoperative follow up of 6 months in patients with GO from 2008 through 2012 were reviewed. Patients were divided into group 1: conjunctival lengthening using spacer graft including 0.3 mm thickness thin Alloderm, group 2: concurrent inferior retractor, and group 3: decompression without retraction correction. Outcome measures included lower eyelid height, reduction of lagophthalmos, cosmetic appearance, complications and need for further surgery were compared between groups.
결과 : Mean improvement of MRD2 from preoperative level was significantly higher in group 1 (2.8 mm at 1 month, 2.1 mm at 6 month) than in group 2 (1.9 mm at 1 month, 1.6 mm at 6 month) and group 3 (1.1 mm at 1 month, 0.8 mm at 6 month) (ANOVA, both p<0.001) after surgery. Postoperative improvement of lagophthalmos and inferior scleral show was significantly larger in group 1 than in group 2 or 3 (all p<0.05). No further surgical correction was necessary in group 1, however further correction of entropion or retraction was necessary in 4 eyes in group 2 or 3.
결론 : Simultaneous correction of lower lid retraction using thin Alloderm during swinging eyelid orbital decompression may maximize the effect of improving lower lid retraction than concurrent inferior retractor recession. Furthermore, not only for cosmetic and functional improvement of retraction and proptosis, but also for patients’ quality of life, one step surgery would be more appropriate to correct retraction and proptosis, as second operation for retraction at previous incision site would be complicated due to adhesion and contracture.
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