June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil: a novel non-surgical treatment for cicatricial ectropion
Author Affiliations & Notes
  • Alexandra Ellyse Levitt
    Bascom Palmer Eye Institute, Miami, FL
  • Bradford Lee
    Shiley Eye Center, San Diego, CA
  • Audrey Cinru Ko
    Bascom Palmer Eye Institute, Miami, FL
  • Wendy Wong Lee
    Bascom Palmer Eye Institute, Miami, FL
  • Footnotes
    Commercial Relationships Alexandra Levitt, None; Bradford Lee, None; Audrey Ko, None; Wendy Lee, Cutera (C), Lumenis (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 4736. doi:
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      Alexandra Ellyse Levitt, Bradford Lee, Audrey Cinru Ko, Wendy Wong Lee; Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil: a novel non-surgical treatment for cicatricial ectropion. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4736.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Periocular scarring can cause significant functional and cosmetic distortions of the eyelid. Surgical treatments for cicatricial ectropion (CE) using full-thickness skin grafting are associated with complications such as recicatrization, d­­onor site morbidity, and textural and pigmentary abnormalities. This case series reports on the efficacy and safety of a novel non-surgical approach to treating CE using ablative fractional laser resurfacing (AFLR) and laser-assisted delivery of 5-fluorouracil (LA 5-FU).

 
Methods
 

The records of three patients with CE who were treated with AFLR and LA 5-FU were retrospectively studied. All patients received at least 3 rounds of AFLR with Erbium:YAG 2940nm, YSGG 2790nm, or CO2 10600nm lasers with the additional use of topically applied LA 5-FU immediately following treatment. Functional and cosmetic outcomes were evaluated via fluorescein and lissamine green staining of the ocular surface, Ocular Surface Disease Index questionnaire (OSDI), Patient and Observer Scar Assessment Scale (POSAS), a questionnaire on patient satisfaction with scar appearance, and clinical photographs documenting the external exam.

 
Results
 

Case 1 presented with CE, lagophthalmos, severe pigmentary and textural skin abnormalities, and exposure keratopathy secondary to facial burns, and underwent 4 AFLR treatments along with LA 5-FU. Following treatment, he had complete resolution of lagophthalmos, CE, brow elevation, and keratopathy (Figure 1). Cases 2 and 3 presented with CE and eyelid retraction following Mohs reconstructions and received 3 treatments of AFLR with LA 5-FU. Both saw improvement in fluorescein staining. Case 2 had complete resolution of CE, symptomatic improvement of dry eye syndrome (reduction of OSDI) and reduced lissamine green staining. Case 3 had partial improvement of CE but ultimately opted for skin grafting. All patients had marked improvement in scar elevation and textural and pigmentary abnormalities and high self-reported satisfaction with treatment. No adverse events were reported.

 
Conclusions
 

AFLR with LA 5-FU appears to be a safe and effective treatment for CE with the additional benefit of improving scar elevation, skin texture and pigmentary abnormalities, all of which cannot be addressed by surgical interventions.  

 
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