Korrektur von Unterlidretraktion mittels eines porösen Polyethylen (Medpor®) Unterlidimplantats

 

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Zusammenfassung

Hintergrund: Die Korrektur von Unterlidretraktion bleibt eine Herausforderung, da alle etablierten Techniken Nachteile aufweisen. Eine rezent beschriebene Alternative ist die Implantation eines ultradünnen Unterlidplatzhalters (Medpor®-Unterlidspacer) aus porösem Polyethylen von hoher Dichte. Wir berichten über unsere Erfahrung mit der Implantation dieses Medpor®-Spacers, vor allem bei Patienten mit Unterlidretraktion im Rahmen einer endokrinen Orbitopathie. Patienten und Methoden: Eingeschlossen wurden alle Patienten, bei denen zwischen März 2003 und November 2004 in der Augenklinik Rotterdam ein Medpor®-Unterlidspacer implantiert worden war. Indikationen und vorangegangene Operationen sowie das Ausmaß eines Exophthalmus wurden festgehalten. Prä- und postoperative Unterlidretraktion wurden verglichen durch Messung des Abstandes zwischen Limbus und Unterlidkante (ALU). Postoperative Komplikationen, Rezidive und Zweiteingriffe wurden erfasst. Ergebnisse: Von 12 Patienten (16 Lider), bei denen der Medpor®-Unterlidspacer implantiert worden war, waren 8 an endokriner Orbitopathie erkrankt. Die gemittelte Nachbeobachtungszeit betrug 7,5 Monate (zwischen 4 und 11 Monaten). Bei 8/16 Lidern wurde das endgültige kosmetische Ergebnis als gut eingestuft, bei weiteren 7/16 Lidern als verbessert. Die Unterlidretraktion war statistisch signifikant reduziert (1,34 mm ± 0,214 (Mittelwert ± Std. Error of Mean), p = 0,004). Komplikationen waren Lidrandkonturabweichungen (4/16 Lidern), bleibendes Irritationsgefühl am Auge (1/16) und Gesichtsfeldeinschränkungen beim Blick nach unten (4/16) sowie ein Rezidiv der Unterlidretraktion (2/16), was bei 3 von 11 Patienten einen Folgeeingriff erforderlich machte. Schlussfolgerungen: Bei sorgfältig selektierten Patienten scheint uns die Implantation eines Medpor®-Unterlidspacers eine gute Alternative zur Korrektur von Unterlidretraktion.

Abstract

Background: The correction of lower eyelid retraction remains a challenge with established techniques having disadvantages. A recently described alternative is implantation of an ultrathin high density porous polyethylene lower eyelid spacer (Medpor® LES). We report our experience on implanting this Medpor® LES, especially in patients with lower eyelid retraction due to Graves’ orbitopathy. Patients and Methods: All patients receiving a Medpor® LES between March 2003 and November 2004 in the Rotterdam Eye Hospital were included. Indications and preceding procedures as well as the degree of proptosis were noted. Preoperative and postoperative lower eyelid retraction were compared by measuring scleral show inferior to the limbus (LSS). Postoperative complications, recurrent retraction and secondary surgical procedures were recorded. Results: Out of 12 patients (16 eyelids) in whom a Medpor® LES was inserted 8 patients suffered from Graves’ orbitopathy. Mean follow-up was 7.5 months (range 4 - 11 months). Final cosmetic outcome was good in 8/16 eyelids and improved in 7/16 eyelids. Lower eyelid retraction (LSS) was reduced significantly (1.34 mm ± 0.214 (mean ± std. error of mean), p = 0.004). Complications included eyelid contour deformity (4/16 eyelids), remaining irritation of the eye (1/16) and problems in down gaze (4/16) as well as recurrent lower eyelid retraction (2/16) requiring further surgery in 3 of 11 patients. Conclusions: In selected patients, insertion of a Medpor® lower eyelid spacer may be a good alternative to correct lower eyelid retraction.

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Dr. A. D. A. Paridaens

The Rotterdam Eye Hospital

Postbus 70030

3000 LM Rotterdam, Niederlande

Email: paridaens@oogziekenhuis.nl