Intraocular Migration of Porous Polyethylene Malar Implant Used for Treacher Collins Eyelid Reconstruction

Bioengineered bilayered grafts for structural and functional posterior lamellar eyelid reconstruction

Eyelid defects involving posterior lamella loss pose significant challenges in reconstructive surgery due to their functional-anatomical complexity. While our previous autologous auricular chondrocyte-derived tissue-engineered cartilage (TEC) grafts successfully maintained normal eyelid morphology, they lacked functional epithelium. This study develops bioengineered bilayered mucosa-cartilage (BMC) grafts through coculture of TEC with oral mucosal explants. The resulting BMC grafts demonstrated a stratified epithelium with barrier integrity and MUC1-producing capacity and a cartilage layer with surgical-grade tensile modulus (1.68 MPa). Upon transplantation into rabbit tarsoconjunctival defects, BMC grafts surpassed both untreated controls and TEC grafts. All grafts demonstrated integration by 2 weeks post-implantation, with transient inflammatory infiltration resolving by 8 weeks. BMC and TEC grafts better preserved eyelid morphology and blinking function than controls throughout the 8-week study. Crucially, BMC-reconstructed eyelids developed continuous stratified epithelia with 5.8-layer MUC1-secreting epithelial cells as early as 2 weeks, progressing to MUC5AC+ goblet cell-rich epithelia by 8 weeks post-implantation. In contrast, TEC counterparts formed thinner epithelia with a lower density of goblet cells. These results confirm the structural integrity and secretory functions of BMC grafts, advancing clinical translation of functional eyelid substitutes.

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

Reconstruction of eyelid defects, especially the posterior lamella, remains challenging because of its anatomical complexity, functional considerations, and aesthetic concerns. The goals of eyelid reconstruction include restoring eyelid structure and function and achieving an aesthetically acceptable appearance. An in-depth understanding of the complex eyelid anatomy and several reconstructive principles are mandatory to achieve these goals. Currently, there are multiple surgical treatment options for eyelid reconstruction, including different flaps, grafts, and combinations of them. This comprehensive review outlines the principles of reconstruction and discusses the indications, advantages, and disadvantages of currently available surgical techniques. We also propose our clinical thinking for solving specific clinical questions in eyelid reconstruction and offer perspectives on new potential methodologies in the future.