Long-Term Outcomes of Upper Eyelid Loading with Platinum Segment Chains for Lagophthalmos: An Adjustable Approach

Abstract

This article reports the outcomes of a 5-year series of individually sutured platinum segment chains for upper eyelid loading. Consecutive case series. Platinum segments of 0.4 and 0.2g were assembled to create the desired weight and were placed in a supratarsal location after levator aponeurosis recession. Primary outcome measures included lagophthalmos on blink, gentle and forced eyelid closure, upper eyelid margin-to-reflex distance (MRD1), corneal staining, static and dynamic validated scoring for facial palsy patients, and complications. Secondary outcome measures were visual acuity, occurrence of induced ptosis, need for further surgery, cosmesis, and quality of life evaluation. During 2013-2018, a total of 122 upper eyelids of 117 patients received platinum segment chains (mean weight, 1.2 ± 0.2 g; range, 0.8-1.6 g) for lagophthalmos. Median follow-up was 17.4months. All grades of lagophthalmos were reduced (P < 0.001), with mean reductions of 3.6, 2.5, and 1.5mm on blink, gentle, and forced closures, respectively. Mean MRD1 was reduced by 1.4mm (P < 0.001). Overall, 36 eyelids (29.5%) underwent revision surgery at 9.1 ± 9.2months after implantation. Of those, 6 eyelids (5.0%) required 2 or more procedures. No platinum allergy occurred. The chain was graded as having no prominence in 77.5% of eyelids; the eyelids were graded as having a normal contour in 70.8% of cases. Platinum segments are US Food and Drug Administration approved and provide benefits of platinum chains with the additional advantages of allowing postoperative adjustability, reduced health care costs, and less likelihood of inducing allergy than gold. Platinum segments are an ideal first-line loading implant for lagophthalmos.