The Clinical Research Of Müller's Muscle–conjunctival Resection For Repairing Upper Eyelid Retraction In Tao And Clinicopathologic Features Of Müller's Muscle

Object1.To study the effect of upper eyelid retraction repair by Müller's muscle–conjunctival resection on ocular surface and eyelids position in patients with Thyroid associated ophthalmopathy(TAO).2.To study the histopathologic features of the Müller's muscle between experimental group and controlled group,and attempt to explore the mechanism about the upper eyelid retraction in TAO patients.Methods1.This is a prospective study.Collected 20 TAO patients(22 eyes)who had mild and moderate upper eyelid retraction at Shanghai Changzheng hospital between April 2015 and July 2015,All patients had Müller's muscle–conjunctival resection under surface anesthesia and local infiltration anesthesia.Collected related informations at preoperative 1day,postoperative 1 day,2 weeks,45 days,3 months.Took pictures by camera,measured MRD1,eyelid crease and fold,skin fold height(SFH),central height of palpebral fissure,myodynamia of upper eyelid,lagophthalmos sign by using ruler and Image J software,and collected some ocular surface signs such as break up time(BUT),FL score,Schirmer test I,calculated ocular surface area,counted scores of ocular surface disease idex(OSDI)and quality of life questionnaire in TAO patients.2.Using the Müller's muscles of 11 patients(13 eyes)who had TAO as the experimental group,Müller's muscles from 4 patients(4 eyes)who had the congenital ptosis diorthosis were the controlled group.All specimens experienced formalin-fixed,paraffin-embedded,sliced and HE staining,then observed the fatty infiltration and fibrosis in the pathological tissue slice under light microscope.Results1.(1)Both ruler method and Image J software method can measure the eyelid.(2)TAO patients eyelid crease and fold and SFH add 2.00 mm and 2.02 mm after Müller's muscle–conjunctival resection at postoperative 3 months.(3)Myodynamia of upper eyelid after Müller's muscle–conjunctival resection at postoperative 3 months has no difference with the pre-operation.(4)TAO patients still have lagophthalmos and lag after Müller's muscle–conjunctival resection at postoperative 3 months.(5)The central height of palpebral fissure and OSA were similar between postoperative 2 weeks and 3 months.(6)There is no correlation between local anesthetics dose and MRD1,eyelid crease and fold,SFH,OSA.(7)3 months after Müller's muscle–conjunctival resection,BUT and OSDI score decreased,quality of life questionnaire improved.2.Two groups have statistically difference(P < 0.001)on fibrosis in Müller's muscle,and no statistically difference(P=0.188)on fatty infiltration in Müller's muscle.Conclusion1.Transconjunctival Müller's muscle recession is a no scarring,fast healing and few complication operation to correct the upper eyelid retraction.After the surgery,eyelid crease and fold adds 2.0mm.The operation can reduce the degree of upper eyelid lag and lagophthalmos.Although the ocular surface damage has increased,but the OSDI questionnaire scores showed patients feel good and the quality of life improved.2.Müller's muscle fibrosis may be part of the reason that causes upper eyelid retraction in TAO patients.