A Comparative Study of Pre- and Postoperative Quantification of Upper Eyelid Retraction in Graves Orbitopathy Using Margin Reflex Distance and Digital Eyelid Image Processing Methods

Program: Abstracts - Orals, Poster Preview Presentations, and Posters
Session: SAT 0528-0545-Thyroid Autoimmunity
Saturday, June 21, 2014: 1:00 PM-3:00 PM
Hall F (McCormick Place West Building)

Poster Board SAT-0544
Thiago Machado Nogueira1, Allan Pieroni Gonçalves, MD, PhD2, Ana Carolina Arato Gonçalves, MD2, Luzia Diegues Silva, MD2 and Mario Luiz Ribeiro Monteiro, MD, PhD3
1Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil, 2Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 3Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Upper eyelid retraction (UER) is the most common feature of Graves Orbitopathy (GO). In clinical practice, the measurement of margin reflex distance (MRD) is usually the method utilized for UER evaluation both pre- and post-operatively. However, this method measures the upper eyelid position only at its central portion (12 o’clock position) and therefore may disregard important abnormalities of its contour (e.g. eyelid flare).

Our objective was to compare the surgical outcome analysis of UER provided by the MRD and a digital image processing contour assessment (DIPCA) method, based on 13 radial midpupil lid distances (MPLDs) at each 15° of the palpebral fissure according to a previously described method.1MRD was obtained from the digitally measured MPLD at the 90° position.

In a prospective randomized interventional study, 21 eyes (12 patients) with UER from inactive Graves Orbitopathy had their eyelid fissure analyzed both by the MRD and a DIPCA method. Exclusion criteria included previous eyelid surgery and strabismus. Patients underwent UER surgical correction by the same surgeon and eyelid fissures parameters measured preoperatively and at 1-month follow-up. Eyes were divided in two groups: group 1 composed by eyes with remaining UER (MRD >5mm) and group 2 without UER (MRD ≤ 5mm) after surgery. Eyes from both groups had their MPLDs plotted in polar plot graphs and had their upper eyelid contour compared to a normal variation range comprehending the interval between the 5th and the 95thpercentiles of the MPLDs of 29 control eyes from 16 randomly chosen Hospital employees without palpebral abnormalities or previous eyelid surgery. Patients in both groups were further subdivided according to their postoperative DIPCA. MRD and DIPCA were compared.

Eight eyes were included in group 1 and 13 in group 2. All eyes in group 1 (with remaining postoperative UER) had poor results on DIPCA while 5 of the 13 eyes in group 2 (considered normal by MRD) still presented an abnormal lid contour. Eyes with postoperative normal MRD and DIPCA had preoperative MRDs (mean ± SD) of 5.85 ± 0.65mm. Eyes with normal postoperative MRD and abnormal DIPCA had preoperative MRD of 6.73 ± 0.81mm while those with abnormal MRD and DIPCA had 7.28 ± 0.73mm. The comparison of postoperative results obtained by MRD and DIPCA (Fisher test, p = 0.006) suggest a significant disagreement between the methods.

We conclude that MRD taken alone is an insufficient method for assessment of UER surgical correction at 1-month postoperative stage. Good results in DIPCA and MRD ≥ 5mm were associated with lower preoperative MRD. More aggressive surgical correction of patients with more UER led to postoperative MRD ≤ 5mm, but was also frequently associated with an abnormal DIPCA.

(1) Ribeiro SFT et al., Ophthal Plast Reconstr Surg, 2012. 28(6): p. 429-433.

Nothing to Disclose: TMN, APG, ACAG, LDS, MLRM

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Sources of Research Support: Fundação de Amaparo à Pesquisa do Estado de São Paulo (FAPESP) Grant 2012/23105-0