Outcomes of Surgical correction of upper eyelid retraction i
Anterior levator disinsertion/reinsertion and Mullerectomy (ALDM) is generally performed to correct upper eyelid retraction in patients with Grave's orbitopathy (GO). The outcome of this procedure and its correlation with clinical parameters were studied.

Retrospective analysis of results of ALDM in 305 consecutive euthyroid patients with burnt-out GO treated was done. From the patient files, data on age, gender, laterality of surgery, smoking history and previous interventions were recorded. For outcome analysis, a qualitative scoring system was used with subdivision into three categories (good (MRD-1 of 4–5 mm, smooth upper eyelid contour and left-right difference of more than 1 mm); acceptable (MRD-1 of 3–4 or more than 5–6 mm), smooth upper eyelid contour and left-right difference of less than 2 mm; poor: if none of the above criteria was met).

Results:
--Of the 305 patients, 166 underwent bilateral and 139 unilateral surgery.

--Regarding eyelids, the outcome of surgery was good in 71.6% acceptable in 15.7% and poor in 12.7%.

--Regarding patients, the outcome was good in 64.3%, acceptable in 15.7% and poor in 20%.

--Concerning bilateral and unilateral surgery, the outcome was good in 60.8% and acceptable in 16.9% of patients after bilateral surgery, and good in 68.3% and acceptable in 14.4% of the patients after unilateral surgery.

--Reoperation was performed in 16% of eyelids and in 22 % of patients. After secondary surgery, the cumulative success percentage was good in 78.6% of eyelids and in 79% of patients.

--Reseachers found no relation between surgical outcome and any other studied parameter, such as age, gender, smoking history and previous intervention such as extraocular muscle surgery and/or orbital decompression.

In conclusion, 64.3 % and 71.6 % of eyelids are successful with the correction of upper eyelid retraction. With a further operation, 79% of patients and eyelids have been successful. No relationship was shown between the results of the surgery and any other parameters such as previous diseases, past interventions or the history of smoking.

Source: https://onlinelibrary.wiley.com/doi/10.1111/aos.14622?af=R
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