A Procedure to Minimize Lower Lid Retraction During Large Inferior Rectus Recession in Graves Ophthalmopathy

Purpose

To determine whether complete detachment of the fascia of the capsulopalpebral head during large inferior rectus recession can help to prevent induced lower lid retraction in Graves ophthalmopathy.

Design

Retrospective consecutive case series.

Methods

Data from patients (39 eyes) with Graves ophthalmopathy undergoing inferior rectus recession were collected retrospectively. Inferior rectus recession was performed by limbus-based incision with adjustable suture. Simultaneous detachment of the fascia of the capsulopalpebral head was achieved by sharp dissection and severing of the fascia. Inferior rectus recession with simultaneous detachment of the fascia of the capsulopalpebral head was performed in 27 eyes and without detachment in 12 eyes. Margin reflex distance (MRD₂) was documented preoperatively and 3 months postoperatively.

Results

Of the 39 eyes included in this study, four eyes with preexisting lower lid retraction in the detachment group improved after surgery. Eighteen eyes in the detachment group exhibited the same MRD₂ values, and only five eyes showed increased MRD₂ values. In contrast, all but one of the 12 eyes in the nondetachment group showed increased MRD₂ values. The average change in the MRD₂ value 3 months after surgery was 0.04 ± 0.59 mm in the detachment group and 1.58 ± 0.73 mm in the nondetachment group. There was a statistically significant difference between the two groups (P < .01).

Conclusions

Simultaneous detachment of the fascia of the capsulopalpebral head during inferior rectus recession can minimize the possibility of lower lid retraction.