Long-term Outcome After Correction of Lower Eyelid Retraction With Donor Sclera in Thyroid Eye Disease

Background: Lower eyelid retraction is a common feature of thyroid eye disease (TED). Various spacer materials have been used for surgical correction, but long-term data on donor sclera are missing. Methods: A retrospective study of all TED patients treated with donor sclera to correct lower eyelid retraction was performed at the Department of Ophthalmology, Haukeland University Hospital, from 1999 to 2023. Data were obtained from hospital records and follow-up examinations. Outcomes were graded as perfect (scleral show of 0 mm), acceptable (0 mm < scleral show ≤ 1 mm), and unacceptable (scleral show >1 mm). Results: Thirty-five patients (29 women, 6 men) with a median age (range) of 57 (20–79) years and a median time from TED onset to surgery of 72 (12–468) months were included. At first follow-up, 3 (0.03–12) months postoperatively, scleral show improved significantly ( P < 0.001) from 2 (1–6) mm preoperatively to 0 (0–4) mm, and margin reflex distance 2 (MRD2) decreased significantly from 7 (6–11) to 5 (4–9) mm. A perfect or acceptable result was achieved in 83% of patients. Estimated graft survival rates were 93.9% at 5 years and 54.2% at 25 years. At final follow-up, 84 (12–275) months postoperatively, a perfect or acceptable outcome was found in 46%. No significant difference ( P = 0.808) was observed between the preoperative MRD2 of 7 (6–11) mm and long-term postoperative MRD2 of 7 (5–11) mm. Conclusions: Correction of lower eyelid retraction with donor sclera in TED patients provides satisfactory short-term outcomes. However, over time, relapse of retraction commonly occurs.