American journal of ophthalmology | 2019
Long term outcomes of upper eyelid loading with platinum segment chains for lagophthalmos: an adjustable approach to eyelid loading.
PURPOSE\nreporting outcomes of a 5-year series of individually sutured platinum segment chains for upper eyelid loading.\n\n\nDESIGN\nconsecutive case series.\n\n\nMETHODS\nPlatinum segments of 0.4g and 0.2g were assembled to create desired weight and placed in supratarsal location after levator aponeurosis recession. Primary outcome measures included lagophthalmos on blink, gentle and forced eyelid closure, upper eyelid margin to reflex distance (MRD1), corneal staining, static and dynamic validated scoring for facial palsy patients and complications. Secondary outcome measures were visual acuity, occurrence of induced ptosis, need for further surgery, cosmesis and quality of life evaluation.\n\n\nRESULTS\nDuring 2013-2018, a total of 122 upper eyelids of 117 patients received platinum segment chains (mean weight 1.2±0.2g , range 0.8-1.6g) for lagophthalmos. Median follow up was 17.4 months. All grades of lagophthalmos were reduced (P<0.001) with a mean reduction of 3.6, 2.5 and 1.5 mm on blink, gentle and forced closure correspondingly. Mean MRD1 was reduced by 1.4 mm (P<0.001). Overall, 36 eyelids (29.5%) underwent revision surgery 9.1±9.2 months after implantation. Of them, 6 (5.0%) required 2 or more procedures. No platinum allergy occurred. The chain was graded as having no prominence in 77.5% of eyelids; the eyelids were graded as having normal contour in 70.8% of cases.\n\n\nCONCLUSIONS\nPlatinum segments are FDA approved and provide benefits of platinum chains with the additional advantages of allowing postoperative adjustability, reducing healthcare costs and being less likely to induce allergy than gold. They are an ideal first-line loading implant for lagophthalmos.