Das Krankheitsbild und die Behandlungsalternativen der Unterlidretraktion bei Patienten mit Morbus Basedow nach transpalpebraler Orbitadekompression : Gegenüberstellung der Ergebnisse nach Konchaknorpel- und PDS-Folienimplantation in Hinsicht auf Funktionalität und Ästhetik
Several biological and synthetical materials are used for the treatment of Lower Eyelid Retraction in patients with Endocrine Ophthalmopathy. The purpose of this retrospective study was to assess and compare the functional and aesthetical postoperative results in 38 patients treated with thin Poly-p-dioxanone foil (PDS-foil) to those in 39 patients treated with auricular cartilage, between 1999 and 2005 at the Department of Plastic Surgery of Dreifaltigkeits-Hospital, Wesseling/Koeln. The records of 77 patients who underwent auricular cartilage transplantation or PDS-foil implantation after transpalpebral orbital decompression were retrospectively reviewed. In addition, in order to assess the postoperative quality of life, patients were interviewed using questionnaires with questions developed specifically for this study. After graft implantation a statistically significant improvement of Margin-Reflex-Distance-2 (MRD-2) as well as of scleral-show values was evident with both materials. However, the assessment of mean difference in MRD-2 and scleral-show values in this study showed that the postoperative results in cases with PDS-foil implantation were far better than those in cases with auricular cartilage transplantation. Mean length of follow-up was 18 months. The results of this study regarding the complications of these methods are following: 23.61% of cases with auricular cartilage transplantation (30.8% of patients) were revised because of graft’s dislocation, while only 15.70% of cases with PDS-foil (26.3% of patients) underwent because of this, a second operation. In 22.22% of cases (25.6% of patients) was the replacement of auricular cartilage with PDS-foil necessary, while 5.71% of cases (5.3% of patients) showed rejection of PDS-foil, necessitating an ear cartilage graft. In 15.27% of cases (20.5% of patients), a thinning and flattening of auricular cartilage graft took place, while 7.14% of cases with PDS-foil (10.5% of patients) demonstrated a threatening erosion of overlying tissues and inevitable extrusion of the implant. The subjective clinical and aesthetical aspects as well as the patients’ satisfaction were also taken in consideration. 97.4% of patients treated with PDS-foil are with the postoperative result satisfied, compared to 79.5% of patients treated with auricular cartilage. In conclusion, the advantages of auricular cartilage transplantation are the avoidance of graft rejection as well the avoidance of graft shrinkage and absorption over time. On the other hand, the advantages of PDS-foil implantation are the easy shaping as well as the fact that they are readily available. This implant is after some months completely resorpted and from connective tissue replaced. Consequently, the eyelid retains its elasticity and the late complications are limited because no permanent foreign body remains in tissues. Regarding the disadvantages of auricular cartilage graft, a second, time-consuming operation of obtaining tissue from the concha is necessary, it demonstrates only a limited availability and usually presents no revascularization. The disadvantages of PDS-foil implantation are the potential erosion of overlying tissues and graft extrusion, the potential graft rejection as well as the costs of this material. Despite the rejection rate of PDS-foil in 5.71% of cases (5.3% of patients), the implantation of this material represents the best alternative, which is attributed to the low infection risk, correction of Dry eye syndrome, as well as to the aesthetical result and patient’s well-being. The implantation of PDS-foil has proven itself to be a very promising therapy-concept for the treatment of Lower Eyelid Retraction. PDS-foil implantation shows its superiority regarding functional and aesthetical results in comparison with auricular cartilage transplantation, especially in patients with Graves’ Ophthalmopathy after transpalpebral orbital decompression who belong to Classes IV and V of Jelks. Further studies of this clinical application are necessary in order to assess the clinical long-term behaviour of PDS- foil in case of its implantation in lower eyelids.
info:eu-repo/classification/ddc/610, Lid, Basedow-Krankheit, Knorpeltransplantation, Spacer, Implantation, Kunststoffimplantat, Keratokonjunktivitis sicca, Medizin, lower eyelid retraction, scleral show, dry eye syndrom, Graves disease, Polydioxanone foil, ear cartilage graft
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