Clinical observation of conjunctival approach Müller's resection combined with levator tendon excision in the treatment of upper eyelid retraction
Objective To investigate the clinical efficacy of conjunctival approach Müller's resection in combination with levator tendon excision in the treatment of moderate to severe upper eyelid retraction in quiescent thyroid-related ophthalmopathy.Methods A case series approach was used in this study.A total of 20 patients(24 eyes)with moderate to severe upper eyelid retraction in thyroid-re-lated ophthalmopathy were selected from May 2020 to August 2022,and Müller's excision combined with levator tendon dissection through conjunctival approach was performed on all patients,who were followed up for 6 months after surgery to evaluate its clinical efficacy.Results At 6 months after surgery,18 of the 24 eyes were completely corrected(75.00％),4 eyes were significantly improved(16.67％),and 2 eyes were ineffective(8.33％),with an overall efficacy rate of 91.67％(22/24);2 of the 24 eyes had postoperative recurrences(8.33％),and 2 of the 24 eyes(8.33％)developed complications,1 eye had ptosis and 1 eye had upper eyelid ectropion,which was fully corrected after upper eyelid levator shortening and ectropion correction,respectively,performed at a later stage;the mean amount of upper eyelid retraction to be corrected was 2.79 mm at 3 months and 2.29 mm at 6 months postoperatively,and the difference was statistically significant(P＜0.001).The psychosocial and visual function scores of the Quality of Life Questionnaire for Patients with Thyroid Associated Ophthalmopathy as well as the postoperative crease width in the vertical axis through the pupil centre,lateral limbus and medial limbus of the cornea at 6 months postoperatively were significantly higher than those before surgery(P＜0.05).Patients with higher values of clinical activity score,upper eyelid retraction and ocular proptosis had a higher postoperative recurrence rate and a lower efficiency rate,and all three of the above indexes showed a negative linear relationship with the efficiency rate of objective appearance evaluation(P＜0.05).Conclusion Conjunctival approach Müller's resection in combination with levator tendon excision is clinically effective in the correction of moderate to severe upper eyelid retraction in quiescent thyroid-associated ophthalmopathy,effectively correcting upper eyelid retraction,increasing upper eyelid width,improving the appearance and thus the quality of life of patients.
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