Long-term Outcomes of Surgical Approaches to the Treatment of Floppy Eyelid Syndrome
Received 27 January 2009; received in revised form 8 September 2009; accepted 9 September 2009. published online 25 January 2010. Corrected Proof
Objective: To identify and describe the different procedures used in the treatment of floppy eyelid syndrome (FES) at Moorfields Eye Hospital and to evaluate their effectiveness.
Design
Cross-sectional study.
Participants
A total of 71 patients who had undergone surgery for FES over a 13-year period since 1995 at Moorfields Eye Hospital were recruited. Retrospective data from 7 patients were also included, providing data for 78 patients.
Methods
Patients underwent a full ocular examination. A survival analysis was determined by plotting Kaplan–Meier curves for each type of procedure encountered. Comparison of survival trends was made using a log-rank test. The possible effects of bias arising from bilaterality of the condition were investigated using a sensitivity analysis and a Cox regression analysis allowing for clusters. Tests for surgeon bias were made using the Fisher exact test.
Main Outcome Measures
Recurrence of the condition. An assessment of recurrence was made clinically by 2 independent observers who were masked to the type of surgery the patient had undergone.
Results
Four different forms of surgical treatment were encountered: (1) Full-thickness wedge excision (FTWE) (26 patients, 33 procedures); (2) Upper lid lateral tarsal strip (LTS) (31 patients, 43 procedures); (3) Medial canthal (MC) and lateral canthal (LC) plication (15 patients, 19 procedures); (4) Medial tarsal strip (6 patients, 6 procedures). A total of 44 of 101 procedures had failed. Superior long-term survival outcomes of both LC/MC plication (P = 0.003) and upper lid LTS (P = 0.001) procedures over FTWE was demonstrated. However, survival comparison between the LC/MC plication and LTS groups did not achieve significance (P = 0.37). No significant difference in outcome between surgeon groups of equivalent experience was demonstrated (P = 0.18). No bias arising from bilaterality of the condition was identified.
Conclusions
These data provide strong evidence of better survival outcomes in FES using the MC/LC plication and LTS procedures in comparison with the FTWE procedure. On the basis of experience from our unit, we recommend that the FTWE procedure be avoided as a form of treatment for FES in favor of the MC/LC plication, LTS, or medial tarsal strip procedure.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
1National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
2Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
3Department of Cell Biology, UCL Institute of Ophthalmology London, United Kingdom
Correspondence Daniel G. Ezra, MA, MRCOphth, National Institute for Health Research Biomedical Research Centre for ophthalmology, 2nd Floor Richard Desmond Childrens Eye Centre, Moorfields Eye Hospital NHS Trust and UCL Institute of Ophthalmology, City Road, London EC1V 2PD
Manuscript no. 2009-119.
Available online: •••.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Funding: By the special trustees of Moorfields Eye Hospital. The authors acknowledge a proportion of their financial support from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.
This article forms part of a doctoral thesis submitted to Cambridge University.
ABSTRACT