Platinum segments: a new platinum chain for adjustable upper eyelid loading.

PURPOSE: Prospective study evaluating outcomes of individually sutured platinum segment chains in upper eyelid loading.

METHODS

Single-centre, single-surgeon, prospective study. Upper eyelid loading with 0.4 and 0.2 g platinum segment chains for lagophthalmos. Segments were sutured to create a desired weight and attached to superior tarsus and distal levator aponeurosis following levator recession.

PRIMARY OUTCOME MEASURES: improvement in lagophthalmos and complications.

SECONDARY OUTCOME MEASURES: cosmesis of eyelid margin contour and implant prominence. Minimum 3-month follow-up.

RESULTS

Eighteen eyelids of 17 patients received segment chains (mean weight 1.2 g, range 0.8-1.6 g) and 3 for exchange of pre-existing gold weights. Median follow-up was 10 (range 6-17) months. Mean blink lagophthalmos improved from 7 (3-10) mm to 3 (0-6) mm (p<0.0001), and gentle closure from 3.2 (0-8) mm to 1.1 (0-4.9) mm (p=0.0004). Twelve patients (71%) reported no prominence, and the remainder, mild prominence only. The chain was graded as having no prominence in 78% (14/18) eyelids. Two required segment adjustments with removal of a single 0.2 g segment at 11 months and transfer of 0.4 g segment to the contralateral eyelid at 16 months, respectively. One complication (posterior, trans-conjunctival exposure above the superior border of the tarsal plate) was seen 12 months post surgery, requiring repositioning.

CONCLUSIONS

Platinum segment chains provide benefits of platinum chains with additional advantages of postoperative adjustibility. They can be used as an addition to pre-existing in situ weights or chains.

TRIAL REGISTRATION NUMBER: REC reference: 13/SW/0146. IRAS project ID: 119022.