Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil: a novel non-surgical treatment for cicatricial ectropion

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.