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Julia Reid, Craig Czyz, Kelly Everman, Kenneth Cahill, Jill Foster, Sandy Zhang-Nunes; Simplified horizontal mattress full-thickness eyelid defect repair. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6372.
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© ARVO (1962-2015); The Authors (2016-present)
To describe outcomes of a simplified method for full-thickness eyelid defect repair.
A retrospective chart review (2006-2012) for patients undergoing repair of full-thickness eyelid defects. Inclusion criteria included: 1. Upper or lower full-thickness eyelid defect; 2. Repair by using a single 6-0 Vicryl (polyglactin 910, Ethicon, Inc., Sommerville, NJ) suture to reapproximate the tarsus and align the lid margin; 3. Pre and postoperative photographs. Postoperative lid margin alignment, vertical position, infection, corneal irritation, need for surgical revision, and any complications from surgery were assessed. Lid margin alignment and vertical position were graded by two oculoplastic surgeons using standardized photographs. Chart review determined presence of infection, corneal irritation, and need for surgical revision.
A total of 36 eyelids (10 upper, 26 lower) from 36 patients (23 women, 13 men) were included in the study. Age ranged from 12 to 87 (mean 63.6, SD 18.2). Indications for surgery were reconstruction following full-thickness lid excision. Follow-up ranged from five days to six years (mean 6.5 months, SD 13.3 months). All upper lid (100%) and the majority of lower lid (92%) repair patients displayed proper margin alignment. Twenty percent of upper lid patients and 31% of lower lid patients had lid margin notching. Vertical lid position was within 0.5 mm of the opposite lid in 83% patients (upper lid 85%, lower lid 83%). Postoperatively, no patients developed wound infection. Six (17%) patients developed corneal irritation. Five had resolution of irritation following epilation and one resolved spontaneously within two weeks. Two (6%) patients developed wound dehiscence that required surgical correction. A patient who had undergone multiple previous eyelid surgeries developed symblepharon following the mattress repair (3%).
Simplified full-thickness eyelid defect repair achieves lid margin alignment and vertical position comparable to the standard, more complex techniques. There were no major complications and a low dehiscence rate. The percentage of patients displaying lid margin notching was likely an effect of follow-up time, as it was seen in one third of those whose last follow-up was less than 10 days postoperatively. We propose this simplified method for full-thickness eyelid repair especially in poorly compliant patients and the emergency department setting.
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