title: Effect of double-fold surgery on spontaneous resolution of Graves' upper eyelid retraction.
abstract: OBJECTIVE
  To investigate the effect of previous incisional double-fold surgery on spontaneous resolution of eyelid retraction caused by Graves orbitopathy (GO) in Asian individuals.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  METHODS
  Patients (N = 30; 39 eyes) with eyelid retraction associated with GO with symptom duration of less than 6 months.
  
  
  METHODS
  Patients who visited the Ophthalmology Department of Severance Hospital, Yonsei University, between January 2010 and December 2011, followed up for more than 6 months and in a euthyroid state with antithyroid drug treatment were included. Patients treated with steroids or who underwent surgery during follow-up were excluded. Upper scleral show was measured as the distance between the central upper lid margin and limbus at initial presentation and after 6 months. Comparative analysis was performed between the 2 groups delineated by history (n = 12; 16 eyes), or lack thereof (n = 18; 23 eyes), of incisional double-fold surgery before onset of GO symptoms and signs.
  
  
  RESULTS
  Patient demographics and initial upper scleral show were not significantly different between groups. In both groups, upper scleral show significantly decreased at 6 months of follow-up (p < 0.001 in both groups); however, improvement of upper scleral show was significantly reduced in patients who had undergone previous double-fold surgery (0.8 ± 0.5 mm) than in nonsurgical patients (1.8 ± 0.5 mm; p < 0.001).
  
  
  CONCLUSIONS
  Graves eyelid retraction resolves spontaneously over time, albeit not completely. Previous double-fold surgery hinders the degree of spontaneous resolution, probably because of the fibrosis and cicatrization between the skin, the subcutaneous layer, and the levator complex.
authors: Yonsei University, College of Medicine.
authors: Dong Kyu
authors: DK
authors: Kim
authors: Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
authors: Moonjung
authors: M
authors: Choi
authors: Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea. Electronic address: yoonjs@yuhs.ac.
authors: Jin Sook
authors: JS
authors: Yoon
mesh_terms: D000328:Adult; D044466:Asian People; D019882:Blepharoplasty; D005141:Eyelid Diseases / Q000503:physiopathology* / Q000601:surgery; D005143:Eyelids / Q000601:surgery; D005260:Female; D049970:Graves Ophthalmopathy / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D012075:Remission, Spontaneous; D012189:Retrospective Studies