April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Complications Of Autologous Dermis Grafts Used As A Posterior Lamellar Spacer In Lower Eyelid Retraction
Author Affiliations & Notes
  • Michael K. Yoon
    Ophthalmology, University of California, San Francisco, San Francisco, California
  • Timothy J. McCulley
    Ophthalmology, University of California, San Francisco, San Francisco, California
  • Footnotes
    Commercial Relationships  Michael K. Yoon, None; Timothy J. McCulley, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 735. doi:
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    • Get Citation

      Michael K. Yoon, Timothy J. McCulley; Complications Of Autologous Dermis Grafts Used As A Posterior Lamellar Spacer In Lower Eyelid Retraction. Invest. Ophthalmol. Vis. Sci. 2011;52(14):735.

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Abstract

Purpose: : Repair of lower eyelid retraction is surgically addressed by implantation of a posterior lamellar spacer. Although autologous hard palate mucosa is considered to be the gold standard material, donor site morbidity has popularized the use of other materials. Autologous dermis grafts have been reported with success. We report complications encountered when using this material.

Methods: : Charts were reviewed in a retrospective manner to identify all patients who underwent lower eyelid retraction repair with autologous dermis graft placement. Complications from surgery were identified, including eyelid malposition, ocular surface irritation, or harvest site problems. Surgical technique involved incision of the conjunctiva at the lower tarsal border with release of the retractors and any scar tissue. The resultant defect size was measured and an appropriate areas was harvested from the post-auricular space. Epithelium of the graft was removed either by high speed burr or scissors. The graft was sutured into the eyelid with the superficial surface facing the ocular surface.

Results: : Fourteen eyelids of thirteen patients were identified. There were 9 men and 4 women. The average age was 56 years (range 24 - 78). Etiologies included Graves’ disease (6), facial nerve palsy (4), cicatricial retraction (2), chronic progressive external ophthalmoplegia (1), and post-trauma (1). Pre-operative inferior scleral show averaged 3.5 mm (range 0.5 - 10) while the post-operative measurement was 0.25 mm (range -1.5 - 2), p = 0.00083. Eleven eyelids were within 1 mm of the inferior corneal limbus, while the other three were within 2 mm. Complications included lower eyelid ectropion (1) and graft keratinization with hair growth (1).

Conclusions: : Autologous dermis can be successfully used as a posterior lamellar spacer for lower eyelid retraction, with improvement of inferior scleral show averaging 3.25 mm. Previously reported complications included development of a pyogenic granuloma at the graft site and transient diplopia. Our patient who developed lower eyelid ectropion was successfully treated with debulking of the graft. The keratinization of the graft caused symptoms of ocular surface irritation, and was remedied by excision of the keratinized epithelium and cryotherapy to the destroy the hair follicles. These complications may be avoided with proper sizing and meticulous debridement of epithelium. Despite the complications, autologous post-auricular dermis is a robust material as a posterior lamellar spacer.

Keywords: eyelid 
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