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Rafizadeh SM, Mirghorbani M, Tavakoli M, Haydar AA. Surgical Correction of Cicatricial Lower Eyelid Retraction: A Systematic Review. Semin Ophthalmol 2024; 39:40-59. [PMID: 37904540 DOI: 10.1080/08820538.2023.2273850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach. METHODS A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis. RESULTS The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods. CONCLUSIONS Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.
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Affiliation(s)
- Seyed Mohsen Rafizadeh
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ali A Haydar
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Zhang Z, Yanjun S, Ye X. Correction of Cicatricial Lower Eyelid Retraction and Entropion With Combined Scar Release, Hard Palate Graft, and Lateral Canthal Suspension. J Craniofac Surg 2023:00001665-990000000-01153. [PMID: 37934969 DOI: 10.1097/scs.0000000000009798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the outcome of a technique-combined scar release, hard palate spacer graft with the recession of the lower eyelid retractors, lateral canthal suspension in the repair of cicatricial lower eyelid retraction, and entropion. METHODS Records of 12 patients with cicatricial lower eyelid retraction and entropion who underwent the surgery from January 2019 to August 2021 were reviewed. Surgical techniques include the following procedures: release of scar, hard palate graft with recession of the lower eyelid retractors, and lateral canthal tightening to strengthen the support of the lower eyelid. The follow-up period was at least 12 months. Postoperative outcomes were evaluated by the improvement of lower eyelid retraction, resolution of eyelid entropion, and complications. RESULTS All patients showed resolution in lower lid entropion, and lower eyelid retraction was significantly improved with a mean elevation of 2.93±0.82 mm. None of the patients had severe complications postoperatively, and both ocular surface symptoms and cosmetic appearance were significantly improved. CONCLUSIONS The technique achieves long-term stable outcomes in cicatricial lower lid retraction and entropion repair with a low morbidity rate.
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Affiliation(s)
- Zhenzhen Zhang
- Department of Facial Plastic and Reconstructive Surgery, Eye and ENT Hospital of Fudan University, Shanghai
| | - Sun Yanjun
- Department of Emergency, the First People's Hospital of Yuanping, Shanxi Province, China
| | - Xinhai Ye
- Department of Facial Plastic and Reconstructive Surgery, Eye and ENT Hospital of Fudan University, Shanghai
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Xu P, Chen P, Gao Q, Sun Y, Cao J, Wu H, Ye J. Azithromycin-carrying and microtubule-orientated biomimetic poly (lactic-co-glycolic acid) scaffolds for eyelid reconstruction. Front Med (Lausanne) 2023; 10:1129606. [PMID: 37261116 PMCID: PMC10227510 DOI: 10.3389/fmed.2023.1129606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Tarsal plate repair is the major challenge of eyelid reconstruction for the oculoplastic surgeon. The ideal synthetic tarsal plate substitute should imitate the microstructure and mechanical strength of the natural eyelid. The aim of this work was to develop a novel bionic substitute for eyelid reconstruction. Methods Three types of poly(lactic-co-glycolic acid) (PLGA) scaffolds (random, oriented, and azithromycin-loaded oriented scaffolds) were prepared using an improved thermal-induced phase separation technique. The microstructure of the scaffolds was examined by scanning electron microscopy. In vitro cytotoxicity was assessed using scaffold extracts. Fibroblast and primary rat meibomian gland epithelial cells (rMGCs) were cultured within the scaffolds, and their behavior was observed using fluorescence staining. Three types of PLGA scaffolds were implanted into rabbit eyelid defect in vivo to evaluate their inductive tissue repair function. Results We successfully fabricated three types of PLGA scaffolds with varying pore architectures, and the axially aligned scaffold demonstrated interconnected and vertically parallel channels. In vitro cytotoxicity tests using scaffold extracts revealed no apparent cytotoxicity. Fluorescence staining showed that both Fibroblast and rMGCs could adhere well onto the pore walls, with fibroblast elongating along the axially aligned porous structure. At 8 weeks post-implantation, all scaffolds were well integrated by fibrovascular tissue. The axially aligned scaffold groups exhibited faster degradation compared to the random scaffold group, with smaller fragments surrounded by mature collagen fibers. Conclusion The study found that the axially aligned scaffolds could well support and guide cellular activities in vitro and in vivo. Moreover, the axially aligned scaffold group showed a faster degradation rate with a matched integration rate compared to the random scaffold group. The findings suggest that the oriented scaffold is a promising alternative for eyelid tarsal plate substitutes.
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Buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction. BMC Ophthalmol 2022; 22:465. [PMID: 36457092 PMCID: PMC9714222 DOI: 10.1186/s12886-022-02699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To evaluate the outcomes of a surgical technique using buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction. METHODS Twelve patients with unilateral cicatricial lower eyelid retraction were enrolled in the study. All patients underwent a four-step surgical technique consisted of release of scars, midface lift, transfer of buccal mucosal membrane to posterior lamella as spacer graft, and canthal tightening. All patients were followed for at least 12 months. RESULTS Mean preoperative Margin-to-Reflex-Distance 2 (MRD2) was 7.73 ± 1.10 mm, compared to mean postoperative MRD2 of 5.04 ± 0.49 mm (P < 0.0001). The mean improvement in retraction was 2.69 mm. Postoperative scleral show was present in only one case and no major complications were observed. CONCLUSION The four-step procedure (scar release, midface lift, buccal mucosal graft and canthal tightening) was an effective procedure to correct cicatricial lower eyelid retractions with acceptable outcomes and a low morbidity rate.
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[Beyond esthetics-Regenerative medicine for severe diseases of the adnexa oculi]. DIE OPHTHALMOLOGIE 2022; 119:878-890. [PMID: 35925347 DOI: 10.1007/s00347-022-01643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Restoration of eyelid and lacrimal functions are important steps on the way to an intact ocular surface. Clinically available substitute tissues or therapeutic options for eyelid reconstruction and lacrimal gland regeneration often reach their limits in patients with severe diseases of the adnexa oculi. Several approaches in regenerative medicine have been intensively researched and clinically tested in recent years. These range from reconstructive approaches with novel tissue matrices in the field of eyelid surgery to stem cell therapies to regenerate lacrimal gland function. MATERIAL AND METHODS The state of the art in the current literature is presented and an overview of clinically applied or currently researched tissues for eyelid reconstruction is given. Furthermore, approaches in stem cell therapy of the lacrimal gland as well as own results are presented. RESULTS Acellular dermis has been successfully used for eyelid reconstruction and represents a viable option in cases of limited availability of autologous tissue. In vitro grown cellular constructs or tissues with genetically modified cells have already been successfully applied in dermatology for the treatment of burns or severe genodermatoses. First studies on stem cell therapy for severe dry eye in Sjögren syndrome showed a safe and effective application of mesenchymal stem cells by injection into the lacrimal gland. CONCLUSION Due to the limitations of currently available replacement tissues, there is a clinical need for the development of new materials for adnexa oculi reconstruction. Constructs grown in vitro with allogeneic and/or genetically engineered cells are slowly making their way into clinical practice. The efficacy and mode of action of stem cells in severe dry eye are subject matters of current clinical trials.
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Osaki M, Osaki T, Monteiro L. Management of eyelid retraction related to thyroid eye disease. Taiwan J Ophthalmol 2022; 12:12-21. [PMID: 35399960 PMCID: PMC8988987 DOI: 10.4103/tjo.tjo_57_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Eyelid retraction related to thyroid eye disease (TED) is a challenging condition. It is one of the main clinical signs and a major diagnostic criterion in TED. This condition may threaten vision due to exposure keratopathy, in addition to its esthetic alterations, which may lead to psychosocial implications and affect the patient's quality of life. Although it is more commonly observed in the upper eyelid, it may be present on both the upper and lower lids. Numerous surgical and nonsurgical treatment modalities have been described and will be reviewed in this article. Management should be based on an individual patient assessment, taking into consideration the disease stage, severity, and clinician experience.
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Juniat V, Ryan T, O'Rourke M, Ng S, O'Donnell B, McNab AA, Selva D. Hughes flap in the management of lower lid retraction. Orbit 2021; 41:733-738. [PMID: 34949152 DOI: 10.1080/01676830.2021.2006721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE We present a retrospective case series on the use of Hughes flap in managing acquired cicatricial lower lid retraction. METHODS This was a multicentre, retrospective case series. Data was collected from medical records across different sites within Australia (Adelaide, Melbourne, and Sydney) and New Zealand (Hamilton). RESULTS Fourteen patients were identified. The aetiology of cicatricial lower lid retraction included previous lid lesion excision and reconstruction, eyelid trauma, orbital fracture repair, orbital radiotherapy, and lateral canthal dystopia from previous lid surgeries. 4/14 (29%) cases had undergone other surgery to correct the retraction prior to the Hughes flap. Pre-operative lagophthalmos due to lower lid retraction was noted in 11/14 (79%) cases with a median 2 mm (range: 1-5 mm). Exposure keratopathy was present in 7/14 (50%) cases. There were no peri-operative complications during Hughes flap reconstruction. One patient had post-operative upper eyelid retraction that did not require any further intervention. One patient had persistent lagophthalmos and exposure keratopathy that is being managed conservatively. One patient had wound dehiscence and further lid retraction following flap division, which required further surgery. Median length of follow-up was 15 months (range: 0.5-84 months). At final review, improvement or resolution of symptoms was seen in 13/14 (93%) cases. CONCLUSIONS A Hughes flap is an effective surgical technique for the management of cicatricial lower lid retraction.
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Affiliation(s)
- Valerie Juniat
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, Australia.,Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, Australia
| | - Tess Ryan
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, Australia
| | - Michael O'Rourke
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Sgj Ng
- Eye Department, Waikato Hospital, Hamilton, New Zealand
| | - Brett O'Donnell
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia
| | - Alan A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Centre for Eye Research Australia Ltd, University of Melbourne, East Melbourne, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, Australia.,Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, Australia
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Kim MJ, Choi YM, Kim N, Choung HK, Khwarg SI. The effects of using spacer grafts on lower-eyelid retraction surgery in patients with facial nerve palsy. Eur J Ophthalmol 2021; 32:2072-2077. [PMID: 34632836 DOI: 10.1177/11206721211051931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effects of the concomitant use of spacer grafts in lateral tarsal strip surgery in patients with facial nerve palsy-related lower-eyelid retraction. METHODS Patients who underwent lateral tarsal strip surgery to correct facial nerve palsy-related lower-eyelid retraction were retrospectively reviewed. Postoperative decreases in marginal reflex distance-2 values at 1, 2 and 6 months were measured along with the effects of spacer grafts. RESULTS Forty-five patients (28 males) were included (mean age: 59.56 years). Mean preoperative marginal reflex distance-2 was 6.87 ± 1.34 mm. Twenty patients underwent lateral tarsal strip surgery only (lateral tarsal strip-only); 25 patients underwent lateral tarsal strip surgery using spacer grafts (lateral tarsal strip + graft). Median (interquartile range) follow-up duration was 12.0 (6.0-23.0) months. Retraction was significantly improved and maintained at 1, 2 and 6 months postoperatively in all patients (mean marginal reflex distance-2: 3.78 ± 1.06 mm, 4.30 ± 1.23 mm and 4.72 ± 1.11 mm, respectively). Surgical outcomes were significantly better in the lateral tarsal strip + graft than in the lateral tarsal strip-only group (Δmarginal reflex distance-2: 3.92 vs. 2.05 mm at 1 month, p < 0.001; 3.38 vs. 1.61 mm at 2 months, p = 0.001; 2.88 vs. 1.69 at 6 months, p = 0.042). Subgroup analyses by spacer graft type revealed no significant differences. CONCLUSION The concomitant use of spacer material in lateral tarsal strip surgery yielded better surgical outcomes than lateral tarsal strip surgery alone. The use of spacer grafts should be considered for correcting severe facial nerve palsy-related lower-eyelid retraction.
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Affiliation(s)
- Mi Jin Kim
- College of Medicine, 37990Seoul National University, Seoul, Korea
| | - Yong Min Choi
- 65462Seoul National University Bundang Hospital, Seongnam, Korea
| | - Namju Kim
- College of Medicine, 37990Seoul National University, Seoul, Korea.,65462Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho-Kyung Choung
- College of Medicine, 37990Seoul National University, Seoul, Korea.,Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang In Khwarg
- College of Medicine, 37990Seoul National University, Seoul, Korea
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Steinsapir KD, Steinsapir S. The Treatment of Post-blepharoplasty Lower Eyelid Retraction. Facial Plast Surg Clin North Am 2021; 29:291-300. [PMID: 33906761 DOI: 10.1016/j.fsc.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Numerous solutions for post-blepharoplasty lower eyelid retraction are reviewed. Patients require permanent recruitment of skin and soft tissue to lengthen the lower eyelid and control of the lower eyelid shape. The authors use a hand-carved expanded polytetrafluoroethylene (ePTFE) implant held with microscrews to provide volume and felting material at the orbital rim and to permanently fix vertically lifted cheek soft tissue into the lower eyelid. The eyelid margin is also controlled with a hard palate graft inset into the conjunctival surface below the tarsus. This eyelid reconstruction avoids tension on the lateral canthoplasty, a point of failure in other solutions.
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Affiliation(s)
- Kenneth D Steinsapir
- Orbital and Ophthalmic Plastic Surgery Division, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Samantha Steinsapir
- Orbital and Ophthalmic Plastic Surgery Division, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Silicone Scaffold Support Using a Bilayer Dermal Regeneration Matrix Template for Correction of Primary or Recurrent Eyelid Retraction. Ophthalmic Plast Reconstr Surg 2021; 37:183-187. [PMID: 32826828 DOI: 10.1097/iop.0000000000001814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of a bilayer dermal regenerative matrix for primary or complex/recurrent eyelid retraction. METHODS Retrospective review of patients undergoing eyelid retraction repair using the bilayer dermal regenerative matrix from 2005 to 2019. Nineteen eyelid surgeries from 15 patients were identified. Collected data included patient demographics, symptoms, preoperative/postoperative lower eyelid position, inferior scleral show, lagophthalmos, etiology of retraction, history of prior retraction surgeries, major/minor complications, and follow-up duration (minimum 6 months). Postoperative measurements were taken at a minimum of 1 week, 3-6 weeks, 2-4 months, and 6 months. RESULTS Postoperatively, 90% of cases had good improvement of lower eyelid retraction (defined as 1 mm or less below the inferior limbus). Postoperative elevation of the lower eyelid ranged 1-3.5 mm compared with preoperative measurements. When used in the upper eyelid for conjunctival scarring, the implant improved the superior fornix depth. Complications were minimal and included transient conjunctival injection, eyelid edema, and foreign body sensation. No patients requested early removal of the silicone layer due to ocular pain. CONCLUSIONS The bilayer dermal regeneration matrix template may be considered a reasonable alternative to other spacers to reduce the vertical palpebral fissure and eyelid malposition in primary, complex, or recurrent cases. It also worked well for first-line correction of thyroid retraction, which tend to be more challenging due to globe proptosis. Suboptimal results may have occurred due to active cicatrizing conjunctival disease, or residual negative vector of the cheek and orbit. High cost may be a consideration, and the bilayer dermal regeneration matrix template was not studied directly against hard palate and other spacer materials.
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Intraocular Migration of Porous Polyethylene Malar Implant Used for Treacher Collins Eyelid Reconstruction. Ophthalmic Plast Reconstr Surg 2021; 37:e73-e75. [PMID: 32732546 DOI: 10.1097/iop.0000000000001786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lower eyelid colobomas associated with Treacher Collins syndrome can be challenging to repair because of associated orbital and midfacial dysostosis. Alloplastic implants such as porous polyethylene have been advocated as readily available malar implants to help improve eyelid retraction. The authors report the first case of porous polyethylene implant insidious migration into the orbit with subsequent scleral penetration. A 14-year-old male with Treacher Collins syndrome, presented with a 3-week history of left eye pain, redness, and eyelid swelling unresponsive to topical treatment. He previously had bilateral lower lid coloboma repair with alloplastic implant placement and full-thickness skin grafts. On exam, he had left eye injection and chemosis, with left hypotropia and complete restrictive ophthalmoplegia. Imaging revealed displacement of implant into the orbit with adherence and impingement on the eye globe.
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González-Cannata MG, González-Hinojosa DI, Aguilera-Ruíz KJ, González-Núñez MP, Medina-Zarco A, Acevedo-Moreno LAG, González-Navarro M. Lateral transorbital canthopexy using a silicone tube in patients with paralytic ectropion. Eur J Ophthalmol 2021; 31:1451-1457. [PMID: 33567886 DOI: 10.1177/1120672121990538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We describe the efficacy of lateral transorbital canthopexy using a silicone tube in managing severe paralytic ectropion. METHODS Patients with paralytic ectropion involving at least two-third of lower eyelid length and scleral exposure of 3 mm or more were considered. A silicone prosthetic was inserted during canthopexy. RESULTS Lateral transorbital canthopexy using a silicone tube was performed on 10 eyelids in nine patients. All patients had corneal surface abnormalities. Scleral exposure resolved completely in three cases. At 8-month follow-up, residual scleral exposure of 1 mm and 2 mm persisted in n = 6 and n = 1 cases, respectively. CONCLUSIONS Lateral transorbital canthopexy using a silicone tube is an effective therapeutic option for paralytic ectropion, facilitating both functional and cosmetic results that proved durable over time.
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Affiliation(s)
| | | | - Karla J Aguilera-Ruíz
- Department of Ophthalmology, Regional Hospital Lic. Adolfo López Mateos, Mexico City, Mexico
| | - Martha P González-Núñez
- Department of Ophthalmology, Regional Hospital Lic. Adolfo López Mateos, Mexico City, Mexico
| | - Alfredo Medina-Zarco
- Department of Ophthalmology, Regional Hospital Lic. Adolfo López Mateos, Mexico City, Mexico
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Martel A, Farah E, Zmuda M, Almairac F, Jacomet PV, Galatoire O. Autologous dermis graft versus conchal cartilage graft for managing lower eyelid retraction: A comparative study. Eur J Ophthalmol 2020; 31:1733-1740. [PMID: 32530712 DOI: 10.1177/1120672120934408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Lower eyelid management is challenging. The conchal cartilage is often considered a spacer of choice for treating lower eyelid retraction. However, dermis graft has also recently been shown to be a viable spacer. The aim of this study was to compare the efficacy of dermis graft to that of conchal cartilage graft in this indication. METHODS A retrospective comparative study was conducted in patients who underwent lower eyelid lengthening with autologous dermis graft (group 1) or autologous conchal cartilage graft (group 2). The main outcome measure was the reduction in inferior scleral show (ISS) assessed by three independent masked surgeons. Secondary outcome measures was the assessment of lagophthalmos and corneal keratitis. Complications were also recorded. RESULTS Twenty-five eyelids of 23 patients were included: 11 and 14 eyelids, respectively in group 1 (dermis graft) and group 2 (conchal cartilage graft). Patient mean follow-up was 12.3 (±12.5) and 7.1 (±7.7) months, respectively. No statistical differences in postoperative ISS reduction, lagophthalmos and exposure keratitis was observed (p = 0.540, p = 0.946, p = 0.934, respectively). Three patients experienced a grade I Clavien-Dindo complication in group 1 and one patient experienced a grade II complication in group 2 (p = 0.540). CONCLUSION Autologous dermis grafts and conchal cartilage grafts provide favorable outcomes without major complications.
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Affiliation(s)
- Arnaud Martel
- Oculoplastic Department, Rothschild Foundation, Paris, France.,Ophthalmology Department, University Hospital of Nice, Nice, France
| | - Edgar Farah
- Oculoplastic Department, Rothschild Foundation, Paris, France
| | - Matthieu Zmuda
- Oculoplastic Department, Rothschild Foundation, Paris, France
| | - Fabien Almairac
- Neurosurgery Department, University Hospital of Nice, Nice, France
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Xu P, Feng X, Zheng H, Feng Z, Fu Z, Gao C, Ye J. A tarsus construct of a novel branched polyethylene with good elasticity for eyelid reconstruction in vivo. Regen Biomater 2020; 7:259-269. [PMID: 32523728 PMCID: PMC7266665 DOI: 10.1093/rb/rbaa001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/19/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
Abstract
Branched polyethylene (B-PE) elastomer was investigated for its potential medical application as a tarsus construct. The in vitro results showed that the B-PE and processed B-PE films or scaffolds did not exhibit noticeable cytotoxicity to the NIH3T3 fibroblasts and human vascular endothelial cells (ECs). The B-PE scaffolds with a pore size of 280–480 µm were prepared by using a gelatin porogen-leaching method. The porous scaffolds implanted subcutaneously in rats exhibited mild inflammatory response, collagen deposition and fast fibrovascularization, suggesting their good biocompatibility. Quantitative real-time PCR analysis showed low expression of pro-inflammatory genes and up-regulated expressions of collagen deposition and vascularization-related genes, validating the results of historical evaluation in a molecular level. The B-PE scaffolds and Medpor controls were transplanted in rabbits with eyelid defects. The B-PE scaffolds exhibited a similar elastic modulus and provided desirable repair effects with mild fibrous capsulation, less eyelid deformities, and were well integrated with the fibrovascular tissue compared with the Medpor controls.
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Affiliation(s)
- Peifang Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China
| | - Xue Feng
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Honghao Zheng
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Zhongwei Feng
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Zhisheng Fu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Changyou Gao
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Juan Ye
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China
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Levator-Muller's recession using labial mucosa as a spacer in severe eyelid retraction. Can J Ophthalmol 2019; 54:678-681. [PMID: 31836099 DOI: 10.1016/j.jcjo.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the use of labial mucosa as a spacer for levator-Muller's recession in correction of severe eyelid retraction. DESIGN Retrospective interventional study. PARTICIPANTS We retrospectively reviewed records of 4 patients with severe upper eyelid retraction not associated with cicatricial diseases of the conjunctiva. METHOD Surgical correction of eyelid retraction was performed by Levator-Muller's recession using autologous mucosal graft (from lip) as a spacer through transconjunctival approach. Eyelid height and contour were the main outcome measures evaluated after surgery. RESULTS There was resolution of dry eye symptoms in all 4 cases. In 2 cases the corrected eyelid height was within 1 mm of the desired lid position. The lid contour was good in 2 cases and satisfactory in 2 cases because of mild lateral flare. The eyelid height remained stationary till the last follow-up, which ranged from Eyelid height and contour were the main outcome measures evaluated after surgery. 6-30 months (mean: 18 months). CONCLUSIONS Labial mucosal graft as a spacer for levator-Muller's recession is a good option for correction of severe upper eyelid retraction. It provides stable eyelid position within 3 months of surgery with no corneal complications.
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Xu P, Gao Q, Feng X, Lou L, Zhu T, Gao C, Ye J. A biomimetic tarso-conjunctival biphasic scaffold for eyelid reconstruction in vivo. Biomater Sci 2019; 7:3373-3385. [PMID: 31233046 DOI: 10.1039/c9bm00431a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Conventional 3D porous scaffolds used as tarsal plate substitute may cause corneal irritation and conjunctival mucoid discharge, and even lead to blindness and cicatricial blepharon deformities. In this study, collagen/chitosan (Col/CS) sponges with thickness of 240 μm, 466 μm, and 724 μm were composited onto poly(propylene fumarate)-co-2-hydroxyethyl methacrylate (PPF-HEMA) polymer networks to obtain the corresponding biphasic scaffolds, which simulate the natural anatomy of posterior lamella of eyelid. These three scaffolds exhibited a porous structure with porosity of ∼90%, simulated elastic modulus, appropriate degradation rate and good biocompatibility. Composited with Col/CS sponge of difference thickness, the scaffolds induced different cellular behaviors such as proliferation, distribution and stratification, by regulating the mechanical properties cells sensed as effective modulus. In a rabbit tarso-conjunctival defect model, the grafted biphasic scaffolds promoted re-epithelization with functional regenerated conjunctiva. Hence, the biphasic composite scaffolds may be a promising substitute for tarso-conjunctival repair.
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Affiliation(s)
- Peifang Xu
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Qi Gao
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Xue Feng
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Lixia Lou
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Tiepei Zhu
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Changyou Gao
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
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Galindo-Ferreiro A, Fernandez E, Weill D, Zornoff DCM, Khandekar R, Corrente JE, Schellini SA. A Web-Based Survey of Oculoplastic Surgeons Regarding the Management of Lower Lid Retraction. Semin Ophthalmol 2019; 34:125-130. [DOI: 10.1080/08820538.2019.1596290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Estrella Fernandez
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut Clínic d‘Oftalmologia, Barcelona, Spain
| | - Daniel Weill
- Department of Ophthalmology, Facultad de Medicina de Buenos Aires, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Denise C M Zornoff
- Distance Education and Health Information Technology Center, Faculdade de Medicina de Botucatu, UNESP, Sao Paulo, Brazil
| | - Rajiv Khandekar
- Diagnostic Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Silvana A Schellini
- Department of Oculoplastics, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology Faculdade de Medicina de Botucatu, UNESP, São Paulo, Brazil
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Beigi B, Khandwala M, Degoumois A, Ogbuehi KC, Gupta D. Lower eyelid excursion: A functional and cosmetically relevant parameter in the treatment of lower eyelid retraction. J Plast Reconstr Aesthet Surg 2018; 72:310-316. [PMID: 30482535 DOI: 10.1016/j.bjps.2018.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/08/2018] [Accepted: 10/28/2018] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to assess and quantify lower lid excursion following repair of lower lid retraction. In this retrospective cohort study, a case review of patients who had undergone ear cartilage grafting for lower lid retraction was undertaken. Surgical correction involved the placement of autologous cartilage between the tarsal plate and lower lid retractors. Measurements taken preoperatively and postoperatively were the marginal reflex 2 (MRD2) and the lower scleral show (LSS). The lower lid excursion on downgaze (LLE) was measured only postoperatively with a comparison made between operated eyes and control eyes. Thirteen eyelids of 10 patients were included in the study. Preoperatively, MRD-2 ranged from 4 to 8 mm (6.5 ± 1.5 mm) - mean ± SD. Postoperatively, MRD-2 ranged from 4 to 6 mm (5.1 ± 0.7 mm). The difference in mean MRD2 was statistically significant (p < 0.05). Preoperatively, LSS ranged from 0 to 5 mm (2.5 ± 1.6 mm). Postoperatively, LSS ranged from 0-1 mm (0.1 ± 0.3 mm). The difference in mean LSS was statistically significant (p < 0.01). Postoperatively, all lower eyelids achieved movement on downgaze. On the operated eyes, the eyelid excursion ranged from 2 to 5 mm (3.1 ± 1.0 mm) on downgaze. On the nonoperated (control) eyes (where the operations were not performed bilaterally), the eyelid excursion ranged from 1 to 4 mm (2.8 ± 1.2 mm). There was no statistically significant difference in the lid excursion of operated and nonoperated eyes (p > 0.05). It is possible to correct lower lid retraction in both primary and secondary positions of gaze if an appropriate surgical technique is employed.
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Affiliation(s)
- B Beigi
- Department of Ophthalmology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, Norfolk, UK
| | - M Khandwala
- Department of Ophthalmology, Maidstone and Tunbridge Wells NHS Trust, UK
| | - A Degoumois
- Department of Ophthalmology, Caen University Hospital Center, Caen Cedex. France
| | - K C Ogbuehi
- Department of Medicine, University of Otago Medical School, Dunedin 9054, New Zealand.
| | - D Gupta
- Department of Ophthalmology, Dunedin Public Hospital, Dunedin, New Zealand
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Correction of Recalcitrant Cicatricial Lower Lid Retraction and Entropion With Transverse Tarsotomy and Tarsoconjunctival Flap. Ophthalmic Plast Reconstr Surg 2018; 35:91-94. [PMID: 30365475 DOI: 10.1097/iop.0000000000001263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To describe a novel technique to correct cicatricial lower lid entropion and retraction using a transverse lower lid tarsotomy with an interposed tarsoconjunctival flap posterior lamellar spacer. METHODS Technique description and retrospective interventional case series. RESULTS Four patients underwent the procedure-two with complications following treatment of sinonasal carcinoma and two with complications following orbital fracture repair. All patients had failed prior posterior lamellar spacer grafts, including donor sclera, dermis-fat graft, and hard palate mucosa. Average time to flap takedown was 20 (11-28) days, with an average follow-up interval of 8.4 (6.2-11.5) months. All patients had resolution of lower lid entropion and significant improvement of lower lid retraction with an average of 2.8 mm (2.0-4.3) of elevation. There were no serious complications, and all patients reported significant improvement in ocular surface symptoms. CONCLUSIONS Transverse tarsotomy combined with a tarsoconjunctival flap is effective for the correction of cicatricial lower lid retraction and entropion in eyelids that have failed surgery with traditional posterior lamellar spacer grafts.
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Park E, Lewis K, Alghoul MS. Comparison of Efficacy and Complications Among Various Spacer Grafts in the Treatment of Lower Eyelid Retraction: A Systematic Review. Aesthet Surg J 2017; 37:743-754. [PMID: 28333254 DOI: 10.1093/asj/sjx003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Lower eyelid retraction is a difficult problem to treat, but it is a prevalent condition and a common complication of blepharoplasty. The use of spacer grafts to increase eyelid height and improve symptoms has been described for a long time, but the optimal choice of spacer graft material is unknown. OBJECTIVES The authors reviewed the currently available evidence to determine the best available spacer graft material in terms of efficacy and complications. METHODS A systematic review of all available literature published between 1985 and the present was performed using the Pubmed, Ovid MEDLINE, and Cochrane library databases. Inclusion criteria were that the studies contain original content assessing the treatment of lower eyelid retraction in humans using a spacer graft and provide quantitative outcomes data. RESULTS One hundred and twelve articles were reviewed following an initial screen using titles, and 19 articles were chosen for inclusion in this systematic review. Analysis of these articles revealed no spacer graft material that is clearly superior to others. CONCLUSIONS Due to a lack of high quality evidence, this review did not reveal one spacer graft material that is clearly superior to others. However, a narrative summary of the available evidence reveals unique sets of advantages and disadvantages associated with the various materials currently available. Further research in the form of well-designed studies will be necessary to further clarify advantages of certain spacer graft materials over others. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Eugene Park
- From the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kevin Lewis
- From the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mohammed S Alghoul
- From the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Abstract
Objectives: To evaluate patient satisfaction and outcomes of surgical treatment of eyelid malpositions secondary to facial palsy. Materials and Methods: Consecutive patients with facial palsy who underwent surgical treatment by the same surgeon at İzmir Katip Çelebi University Atatürk Training and Research Hospital between Jan 2007 and Dec 2012 were included in the study. Ophthalmic examination findings, surgical approaches, and their outcomes were evaluated. A successful result for upper eyelid position was defined as more than 50% reduction in lagophthalmos and induction of less than 2 mm of ptosis. A successful outcome for lower eyelid position was defined as the lower eyelid residing at or within 1 mm above or below the limbus. Linear visual analog scale 1 (VAS-1) (subjective complaints) and VAS-2 (cosmetic outcome), both ranging from 0 to 10, were used to compare preoperative findings with findings at last postoperative visit. Results: The mean age of the 14 female and 21 male patients was 54.5±19.9 years. Gold weight implantation (n=31), lateral tarsal strip (n=22), tarsorrhaphy (n=15), suborbicularis oculi fat elevation (n=16), hard palate graft (n=14), and eyebrow ptosis repair (n=6) were performed. Average follow-up time was 17.9±16.9 months (range, 2-60). Surgical success rates were 90% for upper lids and 75% for lower lids. Mean lagophthalmos decreased from 7.1±2.7 mm to 1.6±1.6 mm postoperatively (p=0.000). The use of lubricating drops and gels was reduced from average preoperative daily values of 5.3±2.5 drops and 1.3±0.6 gel applications to 4.4±1.4 and 0.6±0.6, respectively (p=0.003, p=0.001). Conclusion: An individualized surgical approach tailored according to each patient’s severity of facial palsy and associated malpositions resulted in both functional and aesthetic improvements in our patients.
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Affiliation(s)
- Şeyda Karadeniz Uğurlu
- İzmir Katip Çelebi University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Mustafa Karakaş
- Malatya State Hospital, Ophthalmology Clinic, Malatya, Turkey
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Alsuhaibani AH, Al-Faky YH. Lower Eyelid Retraction Repair with Resorbable Polydioxanone Implants. Middle East Afr J Ophthalmol 2017; 23:311-314. [PMID: 27994395 PMCID: PMC5141625 DOI: 10.4103/0974-9233.194082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To report a unique technique to repair lower eyelid retraction using resorbable polydioxanone implants. PATIENTS AND METHODS: This was a retrospective, consecutive, nonrandomized interventional case series. Patients with lower eyelid retraction after trauma repaired facial fracture, thyroid eye disease, lower eyelid blepharoplasty, and long-standing facial palsy were treated with middle lamellar spacer using absorbable polydioxanone implant. All patients were recruited from the King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only patients with minimum follow-up of 12 months were included in the study. RESULTS: Eight patients (4 males and 4 females) underwent lower eyelid retraction repair using absorbable polydioxanone implant. The mean age was 43 years (range, 23–63 years). All patients noted improved ocular surface symptoms. The improvement in eyelid retraction ranged from 1.5 to 4 mm with an average of 2.7 mm postoperatively. The implant was well tolerated with no major complications. CONCLUSIONS: Several options for spacer materials are available. Absorbable polydioxanone implants seem to be an effective middle lamellar spacer that is a good alternative for repairing middle lamella related lower eyelid retraction and lower eyelid support.
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Affiliation(s)
- Adel H Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Ismailova DS, Podgornaya NN, Ismailova DS, Podgornaya NN. [Corneal damage in patients with thyroid eye disease]. Vestn Oftalmol 2016; 131:98-103. [PMID: 26845879 DOI: 10.17116/oftalma2015131598-103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is a review of literature on etiology, pathogenesis, risk factors, and treatment of thyroid-associated keratopathy. Both Russian and foreign sources have been thoroughly examined.
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Affiliation(s)
- D S Ismailova
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - N N Podgornaya
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - D S Ismailova
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - N N Podgornaya
- Research Institute of Eye Diseases, 11, A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Watanabe A, Katori N, Selva D, Hayashi K, Kinoshita S. Modified auricular cartilage sling for paralytic ectropion. J Plast Reconstr Aesthet Surg 2015; 68:902-6. [DOI: 10.1016/j.bjps.2015.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 03/11/2015] [Accepted: 03/15/2015] [Indexed: 11/28/2022]
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Schiffman JS, Sales-Sanz M, Rebolleda G, Pass AF, Cruz RA, Tang RA. Thyroid orbitopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.13.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Leonard JH, Cohen AJ. Use of the tarSys® for posterior lamellar grafting for lower eyelid malposition. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0882-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liao SL, Wei YH. Correction of lower lid retraction using tarSys bioengineered grafts for graves ophthalmopathy. Am J Ophthalmol 2013; 156:387-392.e1. [PMID: 23659973 DOI: 10.1016/j.ajo.2013.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/13/2013] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the efficacy of decellularized porcine-derived membrane (tarSys; IOP Inc), a bioengineered eyelid spacer graft, for lower lid retraction correction in patients with Graves ophthalmopathy. DESIGN Retrospective observational case series study. METHODS This was a retrospective review of patients with Graves ophthalmopathy undergoing lower eyelid retraction surgery using decellularized porcine-derived membrane bioengineered eyelid spacer grafts from 2008 through 2011. Outcome measures included lower eyelid height (measured from the corneal light reflex to the lower eyelid margin, or marginal reflex distance-2 [MRD2]), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed for functional and cosmetic outcome. RESULTS A total of 32 Graves patients and 37 eyelids underwent lower eyelid retraction surgery using decellularized porcine-derived membrane. There were 10 male and 22 female patients with mean age of 41.8 ± 8.6 years. Mean improvement in MRD2 was 1.4 ± 0.4 mm. Mean reduction of lagophthalmos was 1.3 ± 0.4 mm. There are statistically significant differences between preoperative and postoperative MRD2 and lagophthalmos (paired t test, both P < .0001). No evidence of infection and corneal erosion was noted and none of the patients needed further surgeries. Prolonged lower lid swelling and slight puffy appearance were noted for 6 patients. The swelling and puffy appearance resolved completely 3 months after surgery. Conjunctival granuloma formation was found in 1 patient. The cosmetic result was satisfactory in all cases. CONCLUSIONS Decellularized porcine-derived membrane, a bioengineered graft, is effective for the management of lower lid retraction in patients with Graves ophthalmopathy. It can offer an alternate graft for eyelid reconstruction.
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Reconstruction of total upper eyelid with prefabricated capsule-lined advancement flaps. J Craniofac Surg 2013; 24:1038-41. [PMID: 23714941 DOI: 10.1097/scs.0b013e3182801983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A total upper eyelid defect is a rare problem that may result from tumor excision, trauma, or burns. Reconstruction of a total upper eyelid defect involves the reconstruction of 2 fundamental elements: anterior and posterior lamellae. Because an expander capsule looks like the palpebral conjunctiva with a moist, smooth, white glistening appearance, its use was investigated in the repair of total upper eyelid defects in rabbits. METHODS Sixty-six tissue expanders with the autogeneic conchal chondro-grafts were implanted into the foreheads of 66 rabbits. After 6 to 8 weeks, the sandwich-prefabricated advancement flaps were designed to reconstruct rectangular excisions of the upper eyelid. The cartilage was preliminarily inserted in a flap, formed by tissue expansion, and then transferred to an upper eyelid defect in the rabbit. Histopathology was evaluated at 3 days, 1 week, 2 weeks, 1 month, 2 months, and 4 months after reconstruction. The upper palpebral length was measured after 4 months of reconstruction as a 1-dimension reference point of flap contracture. RESULTS No edema, congestion, infection, corneal damage, or necrosis were observed during the reconstructions. Histopathologic studies revealed that the long-term capsule had a normal conjunctiva-like appearance with a stratified columnar epithelium. The average shortening, measured as the length between inner to outer canthal folds, was inconspicuous. CONCLUSIONS The expander capsule has the potential to act as an effective posterior lamellar substitute of eyelid in a rabbit model. Further studies should be undertaken to see if this represents a good model for a potential human clinical application.
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Sivaraman KR, Aakalu VK, Sajja K, Cortina MS, de la Cruz J, Setabutr P. Use of a porous polyethylene lid spacer for management of eyelid retraction in patients with Boston type II keratoprosthesis. Orbit 2013; 32:247-9. [PMID: 23663113 DOI: 10.3109/01676830.2013.788664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report a novel application of a porous polyethylene implant for lid stabilization and management of eyelid retraction in a patient with an exposed Boston Keratoprosthesis Type II. METHODS A 54-year-old woman with a history of mucous membrane pemphigoid and failed penetrating keratoplasty of the left eye underwent implantation of a Boston Keratoprosthesis (KPro) Type II along with permanent surgical fusion of the upper and lower lids of the left eye in January 2010. At one month follow-up, significant retraction of the lower lid around the inferior margin of the optic was noted, resulting in partial exposure of the keratoprosthesis. The patient subsequently underwent left lower eyelid reconstruction with a porous polyethylene implant to ensure coverage and stability of the KPro. RESULTS Eyelid reconstruction using a porous polyethylene implant resulted in stable retention of the KPro Type II for over 2 years. CONCLUSION In patients with Boston KPro Type II in the setting of severe cicatrizing ocular surface disease, the use of a porous polyethylene implant during eyelid reconstruction around the KPro optic may aid in maintaining eyelid integrity and improving KPro stability and longevity.
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Affiliation(s)
- Kavitha R Sivaraman
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL 60612, USA
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Abstract
BACKGROUND Lower eyelid malposition is the most common complication after lower eyelid blepharoplasty. Although the traditional techniques were effective for correcting lower eyelid malposition, they had potential disadvantages, including additional trauma, additional scar, and long recovery period. OBJECTIVE To evaluate the efficacy of a minimally invasive surgical technique using Aptos thread for postblepharoplasty lower eyelid malposition. METHODS A retrospective review of all patients undergoing lower eyelid malposition surgery via a minimal invasive, Aptos thread technique from June 2005 to June 2010. Symptoms, including epiphora, ocular irritation, conjunctivitis, and measurement of lower eyelid scleral show (measured from the inferior limbus of cornea) were recorded. Presurgery and postreconstruction photographs were reviewed for functional and cosmetic outcome. RESULTS A total of 15 patients (24 eyelids) underwent successful lower eyelid malposition surgery using this minimally invasive technique. On clinical examination, all cases of lower eyelid retraction stemmed from overzealous excision of skin and orbicularis. After a follow-up interval of 12 to 25 months (mean, 15 months), inferior corneal exposure and ocular symptoms were corrected thoroughly. The decrease in lower eyelid retraction was 2.7 ± 0.9 mm. The functional and cosmetic result was satisfactory in all cases. CONCLUSIONS Aptos thread technique is a safe, effective, and the least invasive method of managing mild and moderate postblepharoplasty lower eyelid malposition secondary to shortening anterior lamella.
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Abstract
The aims of surgical treatment in Graves's orbitopathy (GO) are improvement of function and appearance. Since antiinflammatory treatment of GO rarely results in a complete resolution of symptoms, surgical treatment is very important for patients well being. Rehabilitative surgery includes orbital decompression, squint correction, lid lengthening and blepharoplasty and these procedures have to be performed in centres of expertise. Various techniques have been developed for orbital decompression which allow now a graded approach to proptosis reduction and optic nerve decompression in emergency situations. Extraocular muscle recessions can be successfully performed to treat most of the patients with diplopia. Only large or complex squint angles are difficult to treat and step by step procedures are recommended in these patients. Lid lengthening procedures are performed most often in GO patients and should be performed under local anaesthesia to get a good result. Serious complications are rare.
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Affiliation(s)
- Anja Eckstein
- University Eye Hostpital Essen, Department Neuroophthalmology, Strabism and Oculoplasics, Hufelandstrasse 55, Essen 45122, Germany.
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Borrelli M, Unterlauft J, Kleinsasser N, Geerling G. Decellularized porcine derived membrane (Tarsys®) for correction of lower eyelid retraction. Orbit 2012; 31:187-189. [PMID: 22551374 DOI: 10.3109/01676830.2012.669012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Retraction of the lower eyelid can be consequence of medical and surgical conditions. Various kinds of allotransplants and biomaterial have been used to correct it; we report on the surgical correction of lower lid retraction with a decellularized porcine derived membrane (Tarsys(®)). A 49-year-old patient with a history of adenoid cystic carcinoma in the pterygo-palatine fossa, requiring extensive surgery and repeated radiotherapy, presented with 6 mm lagophthalmus and exposure keratopathy secondary to facial nerve palsy. The lower lid malposition was corrected with a Tarsys(®) implant. Three months after surgery no lagophthalmos was present and substantial relief of signs and symptoms of ocular surface disease and good symmetry between right and left eye was achieved. If general condition or morbidity in potential donor sites hamper harvesting autologous graft material to support the lower lid, bioengineered xenografts can be used successfully to correct eyelid malpositions such as lower lid retraction.
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Affiliation(s)
- Maria Borrelli
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany.
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Composite septo-retractor recession; a surgical technique for lower-eyelid retraction and review of the literature. Ophthalmic Plast Reconstr Surg 2011; 27:447-52. [PMID: 21946771 DOI: 10.1097/iop.0b013e3182286962] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the outcomes of a technique for correcting lower-eyelid retraction with composite recession of the inferior retractor and orbital septum complex, release of the lateral horn of the lower-eyelid retractors, and the orbito-malar ligament (OML) followed by skin, orbicularis, and conjunctival advancement. METHODS We performed a retrospective, noncomparative review of consecutive procedures performed on patients with lower-eyelid retraction undergoing composite septo-retractor recession for lower-eyelid retraction over a 4-year period, performed or supervised by a single surgeon (RM). Outcomes are based on postoperative standard photographs, including central pupil to lower-eyelid distance, inferior scleral show, and subjective improvement in lower-eyelid lateral flare. RESULTS We reviewed 26 eyes of 16 patients (12 men, 4 women; mean age, 61.0 ± 14.3 years). Causes of lower-eyelid retraction included involutional (n = 6), thyroid orbitopathy (n = 4), previous lower-eyelid surgery (n = 3), mechanical secondary to proptosis (n = 1), Crouzon syndrome (n = 1), and longstanding facial nerve palsy (n = 1). Mean lower-eyelid elevation achieved was 1.4 mm ± 1.3 mm (range, 0.2 to 6.6 mm; p = 0.001). Scleral show improved by 1.0 ± 0.7 mm (range, 0.0 to 2.9; p = <0.001). Preoperatively, all patients had an altered lower-eyelid contour with lateral flare, 89% cases being graded "significant." Lower-eyelid contour improved postoperatively, with only 19% graded "significant" lateral flare (p = <0.0001). No significant complications occurred, although one patient required excision of a secondary lateral canthal cyst. CONCLUSION Composite recession of the inferior retractor and orbital septum complex combined with release of the inferior retractor lateral horn and the OML significantly improves lower-eyelid height and contour in cases of lower-eyelid retraction and should be considered a useful option for this condition.
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Abstract
In 2008, the authors published data from a series of 69 patients (129 eyelids) who had been treated with EnduraGen during eyelid surgery. They have since gained experience with this material in an additional series of 19 patients, in whom the results have continued to be promising. In this article, the authors discuss some of the subtleties inherent in this procedure and present their surgical technique.
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Sahin I, Aykan A, Acikel C, Alhan D, Isik S. Total lower eyelid reconstruction with superficial temporal fascia flap and porous polyethylene implant: a case report. J Plast Reconstr Aesthet Surg 2011; 65:110-3. [PMID: 21778127 DOI: 10.1016/j.bjps.2011.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/11/2011] [Accepted: 06/10/2011] [Indexed: 11/18/2022]
Abstract
Total reconstruction of the eyelid after serious periorbital injury is a challenging procedure for plastic and reconstructive surgery. Although several methods have been used for reconstructing the eyelids, such as advancement flap with fascia lata sling, island mucochrondrocutaneous flap, prefabricated temporal island flap, porous polyethylene and superficial temporal fascia flap, creating a supportive eyelid for housing an artificial eye without complication is still an ongoing problem. In the case presented, superficial temporal fascia flap with porous polyethylene was used for the reconstruction of total lower eyelid.
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Affiliation(s)
- Ismail Sahin
- Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, 06010 Etlik, Ankara, Turkey
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Abstract
Thorough preoperative evaluation with meticulous surgical planning to achieve facial aesthetic balance between the forehead, eyelids, and midface is imperative to avoid or decrease potential functional and/or cosmetic complications in cosmetic periocular surgery. Before performing surgery, the physician should be aware of the patient's history of dry eyes, previous facial trauma, previous injection of Botox Cosmetic, history of previous laser-assisted in situ keratomileusis, and past facial surgery. A full evaluation should be performed on the upper eyelid/brow region to assess for the presence of brow ptosis, brow/eyelid asymmetry, dermatochalasis/pseudodermatochalasis, eyelid ptosis, and deep superior sulcus. On the lower eyelid/cheek examination, special attention should be directed to the diagnosis of underlying negative vector, dry eyes, prominent eyes, lower lid retraction, ectropion, lateral canthal dystopia, lower eyelid laxity, scleral show, and lagophthalmos, with a rejuvenation goal that focuses on obtaining a youthful fullness through repositioning and reinforcing efforts to avoid the negative effects of hollowness. Intraoperative and postoperative medical and surgical management of cosmetic periocular surgery complications focus on decreasing the risk of postoperative ptosis, lagophthalmos, lid retraction, and lid asymmetry, with special attention to limiting the risk of visual loss secondary to orbital hemorrhage.
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Affiliation(s)
- William P Mack
- Division of Oculoplastics Surgery, University of South Florida, Tampa, FL, USA.
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Abstract
UNLABELLED Eyelid tumors constitute about 40% of all cancers located in the orbital region. Most commonly, they are basal cell carcinomas, in 90% of cases located in the lower eyelid and medial canthus. The purpose of our study was to present the management and to overview the results of surgical treatment of eyelid tumors. MATERIALS AND METHODS One hundred ninety-three patients, 89 men and 104 women, aged 16 to 87 years (mean, 63.5 years) with eyelid tumors were treated in Plastic Surgery Hospital in Polanica-Zdrój in the years 1985 to 2008. The patients were divided into 2 groups: group 1 (n = 148) was composed of patients operated on primarily in our hospital, and group 2 (n = 45) was composed of patients operated on in other hospitals, admitted for recurrence. All the patients underwent surgery involving resection of the tumor and simultaneous eyelid reconstruction. The preparations were evaluated histopathologically. Various surgical modalities were used, depending on the extent and location of the tumor. RESULTS Recurrence developed in 13 patients in group 1 (8.7%; 5 women and 8 men) and in 9 patients in group 2 (20%; 5 women and 4 men). CONCLUSIONS Tumors, usually basal cell carcinoma, originate mainly in the lower eyelid and medial canthus. Surgery should be performed as soon as possible after onset of the primary tumors and should include resection and reconstructive therapy. The highest risk of recurrence is in case of squamous cell and basospinocellular tumors, and especially in melanoma. The aim of reconstructive therapy is to reconstruct aesthetically and functionally effective eyelid.
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Abstract
Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.
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Affiliation(s)
- T Schrom
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, HELIOS Klinikum Bad Saarow, Pieskower Str. 33, 15526, Bad Saarow.
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Abstract
PURPOSE To create and validate a new model of lower eyelid fibrosis in Dutch-belted rabbits. METHODS Five Dutch-belted rabbits were injected with a transcutaneous 1-ml injection of standard 95% ethanol alcohol just inferior to the eyelid margin of one lower eyelid. A control injection of 1 ml of balanced saline solution was given to the opposite eyelid. A small tattoo was placed on the skin overlying the inferior orbital rim and used as a measuring point of reference in relation to the lower eyelid margin. Analysis was twofold: eyelid measurements were made over 8 weeks to determine the presence of eyelid shortening, and a histopathologic analysis was performed. RESULTS Mean lower eyelid shortening was greater in the ethanol alcohol intervention eyelids than the control group (-3.4 mm +/- 1.67 mm vs. 0.5 mm +/- 0.71 mm, p = 0.01). Histopathologic analysis revealed extensive fibrosis in the ethanol alcohol invention eyelids compared with the control group. CONCLUSIONS Ethanol alcohol induces eyelid fibrosis and lower eyelid shortening. This may be a useful model in the future testing of novel surgical or pharmacologic treatments.
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Heo H, Yoon KC, Park YG, Park SW. Surgical Correction of Lid Retraction with a Silicone Sponge in Congenital Fibrosis of the Extraocular Muscles. Chonnam Med J 2010. [DOI: 10.4068/cmj.2010.46.3.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hwan Heo
- Department of Ophthalmology, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Kyoung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Yeoung-Geol Park
- Department of Ophthalmology, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Medical School & Hospital, Gwangju, Korea
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Mavrikakis I, Francis N, Poitelea C, Parkin B, Brittain P, Olver J. Medpor lower eyelid spacer: does it biointegrate? Orbit 2009; 28:58-62. [PMID: 19229747 DOI: 10.1080/01676830802414855] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the histopathologic findings of explanted Medpor lower eyelid spacers (LES) in complicated cases. MATERIALS AND METHODS Four cases of lower eyelid retraction due to thyroid orbitopathy (n = 2), facial nerve palsy (n = 1), and post-enucleation socket syndrome (n = 1) were treated with Medpor LES. RESULTS All implants were removed between 6 months to 2 years following their original insertion due to exposure, poor stability, or contour. Histopathology of the implants showed fibrosis and vascularization although clinically, at the time of removal, did not appear vascularized. In addition, immunohistochemistry was positive for Factor VIII related antigen and CD34, thus highlighting the presence of vessels in the pores and around the implant. CONCLUSION To our knowledge, we are the first to report histopathologic findings of explanted high-density porous polyethylene implants from the lower eyelid in humans. Although this study shows that Medpor LES does biointegrate, we advocate using it sparingly due to associated complications such as exposure, poor stability, and contour.
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Affiliation(s)
- Ioannis Mavrikakis
- Sussex Eye Hospital, Brighton and Sussex University Hospitals, Brighton, UK.
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44
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Howard GR. Eyelid Retraction. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Use of Porcine Acellular Dermal Matrix (Enduragen) Grafts in Eyelids: A Review of 69 Patients and 129 Eyelids. Plast Reconstr Surg 2008; 122:1206-1213. [DOI: 10.1097/prs.0b013e3181845888] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Schrom T, Habermann A. Temporary ectropion therapy by adhesive taping: a case study. Head Face Med 2008; 4:12. [PMID: 18638420 PMCID: PMC2515302 DOI: 10.1186/1746-160x-4-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 07/21/2008] [Indexed: 02/01/2024] Open
Abstract
Introduction Various surgical procedures are available to correct paralytic ectropion, which are applied in irreversible facial paresis. Problems occur when facial paresis has an unclear prognosis, since surgery of the lower eyelid is usually irreversible. We propose a simple method to correct temporary ectropion in facial palsy by applying an adhesive strip. Patients and methods Ten patients with peripheral facial paresis and paralytic ectropion were treated with an adhesive strip to correct paralytic ectropion. We used "Steri-Strips" (45 × 6.0 mm), which were taped on the carefully cleaned skin of the lower eyelid and of the adjacent zygomatic region until the prognosis of the paresis was clarified. In addition to the examiner's evaluation of the lower lacrimal point in the lacrimal lake, subjective improvement of the symptoms was assessed using a visual analogue scale (VAS, 1–10). Results 9 patients reported a clear improvement of the symptoms after adhesive taping. There was a clear regression of tearing (VAS (median) = 8; 1 = no improvement, 10 = very good improvement), the cosmetic impairment of the adhesive tape was low (VAS (median) = 2.5; 1 = no impairment, 10 = severe impairment) and most of the patients found the use of the adhesive strip helpful. There was slight reddening of the skin in one case and well tolerated by the facial skin in the other cases. Conclusion The cause and location of facial nerve damage are decisive for the type of surgical therapy. In potentially reversible facial paresis, procedures should be used that are easily performed and above all reversible without complications. Until a reliable prognosis of the paresis can be made, adhesive taping is suited for the temporary treatment of paralytic ectropion. Adhesive taping is simple and can be performed by the patient.
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Affiliation(s)
- Thomas Schrom
- Department of Oto-Rhino-Laryngology, Helios Clinics Bad Saarow, Germany.
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Treatment of Lower Eyelid Retraction by Retractor Release and Posterior Lamellar Grafting: An Analysis of 659 Eyelids in 400 Patients. Ophthalmic Plast Reconstr Surg 2008; 24:207-12. [DOI: 10.1097/iop.0b013e3181706840] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Auricular Cartilage Grafting to Correct Lower Conjunctival Fornix Retraction and Eyelid Malposition in Anophthalmic Patients. Ophthalmic Plast Reconstr Surg 2008; 24:13-8. [DOI: 10.1097/iop.0b013e31815efe35] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eski M, Sengezer M, Turegun M, Deveci M, Isik S. Contour Restoration of the Secondary Deformities of Zygomaticoorbital Fractures With Porous Polyethylene Implant. J Craniofac Surg 2007; 18:520-5. [PMID: 17538312 DOI: 10.1097/scs.0b013e318053432c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Inappropriate treatment or untreated fractures of the zygomaticoorbital area results in secondary deformities such as loss of malar projection, enophthalmos, and dystopia. Secondary deformities can be corrected with osteotomies, contour restoration, or a combination of both. Contour restoration can be performed with using onlay grafting with autogenous material or alloplastic implants. In this study, mild to moderate secondary deformities of zygomaticoorbital fractures were corrected with porous a polyethylene implant, which is a highly biocompatible, durable, and stable material. The number of patients who have no surgical treatment at the time of their initial injury was 15, whereas the number of patients who have an initial treatment that resulted in secondary deformities was seven. Twelve of 15 patients had only loss of cheek projection and three of the 15 patients had dystopia and loss of cheek projection. The remaining seven patients had secondary deformities resulting from skeletal surface contour abnormality as a result of comminuted fractures. In 17 of the patients, we used a subciliary approach while using the old incision scar for access in the remainder. In 22 patients, 24 implants were used. Porous polyethylene implant was carved outside in according to the existing contour deficit and was placed in the subperiosteal plane and fixed with titanium screws. The mean follow-up period was 13 months (range, 6-24 months). In this follow-up period, there was no implant extrusion, exposition, infection, or any complication resulting from subciliary incision. Patients were satisfied with the results. The best result can be achieved with porous polyethylene implant in contour restoration of mild to moderate secondary deformities of zygomaticoorbital fractures. The use of this implant in the zygomaticoorbital area is safe and has minimal morbidity.
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Affiliation(s)
- Muhitdin Eski
- Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
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Garibaldi DC, Robinson MR, Lee SS, Park DJJ, Fine HF, Deitz L, D'Anna S, Yuan P, Ranson N, Grant MP, Iliff NT, Merbs SL. New Corticosteroid-eluting Porous Polyethylene Implant for the Management of Lower Eyelid Retraction: A Pilot Study. Ophthalmic Plast Reconstr Surg 2006; 22:424-9. [PMID: 17117094 DOI: 10.1097/01.iop.0000245487.61479.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Lower eyelid retraction after trauma presents a challenging management problem. We postulated that a porous polyethylene (pPE) eyelid spacer coated with a polyvinyl alcohol (PVA) and triamcinolone acetonide (TA) matrix could deliver corticosteroid locally over extended periods and modulate inflammation and scar formation. We designed a pPE corticosteroid-eluting implant and evaluated its characteristics in vitro and in vivo. METHODS The release characteristics of pPE implants coated with a PVA/TA matrix of low, intermediate, and high doses of TA were studied in vitro. The implants were then placed in the posterior lamella of lower eyelids of Dutch Belted rabbits for 12 weeks. Clinical events were recorded and eyelids were examined for gross and histologic features, including capsular thickness and degree of vascularity, fibrovascular ingrowth, and inflammatory response. RESULTS In vitro, implants coated with the intermediate and high doses of TA released the drug at a steady rate for at least 78 days. In rabbits, the PVA and PVA/TA coating prevented fibrovascular ingrowth, except where breaks in the PVA/TA coat were present. Implants with PVA/TA coating demonstrated less inflammation and capsule vascularity. An inverse correlation between TA dose and capsule thickness was noted. CONCLUSIONS We describe a novel drug-release pPE eyelid implant. The corticosteroid-eluting implant demonstrated antiangiogenic and anti-inflammatory properties, which could prove beneficial in the treatment of lower eyelid retraction.
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Affiliation(s)
- Daniel C Garibaldi
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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