Treating the Golden Implant Visibility on a Paralytic Eye by Using the Capsule Shield Technique.

Static upper eyelid weight loading is a well known treatment option for patients who suffer from paralytic lagophtalmus. Golden implants may cause some complications such as extrusion, postoperative ptosis, visibility of the implant from the skin, infection, or dislocation. Our patients applied to our clinic with discomfort of the implant's easily noticeable visibility in their daily life. They were scheduled the operation programme for reducing visibility of implant.In operation, capsule formation has seen and dissection begun preserving the capsule formation. The capsule has opened on its cranial edge and implant has been removed. By this maneuver, 2 layers of capsule were dissected from surrounding tissues without separating its caudal edges from the upper tarsal fold. These 2 layers were sutured to each other providing strong fibrous shield with the aim of preventing implant visibility. A new pocket has been created under this fibrous shield.Capsule shield technique is provided to replace the implant and prevent revisibilation by using forceful fibrous and highly vascular 2 layers of capsule. This technique seems 1 step ahead than autogenous grafts that require secondary surgical area and bring donor site complications with itself. It does not contain any risk of developing foreign body response and graft infection, unlikely nonautogenous/autogenous graft materials. Also, in the capsule shield technique, operation duration will be shorter and hospitalization period will be shorter compared with techniques using barrier materials because it does not require any additional surgical intervention in donor area. In addition, the authors keep the apeuneurosis in anatomical position and no other new incisions are required. Since no biomaterials are required, this technique also avoids donor site morbidity.