Effectiveness of the Gold Weight Trial Procedure in Predicting the Ideal Weight for Lid Loading in Facial Palsy: A Prospective Study

Abstract

To evaluate the effectiveness of the gold weight trial procedure in predicting postoperative eyelid closure after gold weight implantation surgery for facial palsy. Prospective, interventional case series. Patients with facial palsy undergoing gold weight implantation were enrolled prospectively to undergo the standard gold weight trial procedure. The criteria for ideal gold weight were defined before surgery as a minimum 50% reduction in lagophthalmos without induction of more than 2 mm ptosis during the trial procedure. The corrected weight (ideal gold weight + 0.2 g) was implanted in the pretarsal space. The main outcome measure was reduction in lagophthalmos according to predefined criteria at six weeks after surgery. Thirty eyes of 29 patients underwent gold weight implantation. The mean age at surgery was 41.6 years, and the median predicted ideal gold weight was 1.2 g. The mean preoperative lagophthalmos of 7 mm reduced to 2.3 mm at six weeks after surgery. As defined by the success criteria, undercorrection was noted in nine eyes (30%) at six weeks after surgery. A preoperative lagophthalmos of 8 mm or more was noted in seven (77.8%) of nine eyes in the undercorrection group, compared with six (28.6%) of 21 eyes in the success group. Six of the nine failures required implant exchange. The ideal gold weight as estimated by the trial procedure (with 0.2 g correction factor) led to undercorrection in 30% cases. Undercorrection was common (78%) in patients with preoperative lagophthalmos of more than 8 mm.