CORRECTION OF LOWER EYELID RETRACTION IN THYROID EYE DISEASE - A RANDOMIZED CONTROLLED TRIAL OF RETRACTOR TENOTOMY WITH ADJUVANT ANTIMETABOLITE VERSUS SCLERAL GRAFT

Background/aims-Lower eyelid retraction in thyroid eye disease contrib utes to ocular discomfort and an unsightly appearance, especially if a symmetrical. The use of donor scleral grafts is effective in lengtheni ng the lower eyelids but carries a risk of virus transmission. Other t echniques, including those which do not use grafts, need to be compare d with scleral grafts. Recurrent retraction is a recognised complicati on of thyroid eyelid surgery; therefore, the authors investigated the use of antimetabolites to reduce postoperative fibrosis.Methods-In thi s prospective randomised controlled trial of 25 patients (35 eyelids), the use of donor sclera in 20 lower eyelids (13 patients) was compare d with partial tenotomy of the anterior part of the lower eyelid retra ctors (ALER) with adjuvant peroperative antimetabolite in 15 lower eye lids (12 patients). A 5 minute peroperative application of either 5-fl uorouracil (25 mg/ml) in nine lower eyelids (eight patients) or mitomy cin C (0.2 mg/ml) in six lower eyelids (four patients) was used to foc ally inhibit fibroblasts. Follow up ranged from 3 to 18 months (mean 7 .8). Results-One month after surgery the results of both groups were s imilar. However, at 3 months after surgery the results of scleral graf ting were better than tenotomy with antimetabolites: 3/12 patients (25 %) treated with tenotomy and adjuvant antimetabolite required subseque nt surgery using grafts for correction of recurrent retraction. There were no significant complications associated with the use of antimetab olites in the eyelid in the doses used in this study.Conclusions-This randomised prospective trial shows that donor scleral grafts were more effective in the long term than partial tenotomy with adjuvant antime tabolite in the correction of lower eyelid retraction associated with thyroid eye disease. The use of peroperative antimetabolites in the lo wer eyelid was safe.