Gold weight implantation: a better way?

Purpose: To introduce an alternative surgical technique for gold weight implantation for the treatment of lagophthalmos. We suggest that unwrapped intraorbital gold weight implantation provides adequate function, better cosmetic appearance, and lower morbidity than conventional implantation with wrapped or unwrapped pretarsal gold weights.
Methods: The charts of a single surgeon were reviewed (1994 to 2003). All patients who underwent intraorbital gold weight implantation were included in the study. The technique was noted to be consistent with intraorbital fixation of a custom 2.2-gm gold weight (MedDev Corporation, Sunnyvale, California). Implants were not wrapped. Efficacy was defined as elimination of exposure keratopathy with preservation of the visual axis. Morbidity was defined as extrusion of the weight, shift of positioning requiring intervention, inflammation/infection of the eyelid, or poor cosmetic appearance.
Results: Of 59 patient charts reviewed, 2 patients had morbidity as defined by our study: One had shifting of the gold weight, necessitating repositioning of the weight; the other had extrusion of the gold weight, requiring its removal. The remaining patients had no complaints or cosmetic concerns. Follow-up examinations found no incidence of exposure keratopathy.
Conclusions: We found intraorbital gold weight implantation, without the use of a wrap, to be simple and effective, with adequate function, an acceptably low postoperative morbidity rate, and an excellent cosmetic outcome.