Abstract
Purpose: :
Inner lamellar contracture of the eyelids and large, full-thickness eyelid defects in cases of trauma, burns, tumor resection as well as congenital and iatrogenic, post-surgical abnormalities often require complex reconstructive efforts. Numerous posterior lamellar graft options available include autologous (dermis), hard palate (keratin), auricular cartilage (chondrocytes), among others. These options can be effective but are not ideal. Frequent complications including graft retraction/resorbtion, unsightly bulk and color mismatch may result in a sub-optimal functional and cosmetic result. This study was performed to describe promising, early clinical experience with tarSysTM, a bioengineered prostheses for eyelid reconstruction.
Methods: :
Retrospective review of 16 patients (22 eyelids) who underwent eyelid reconstruction using tarSysTM bioengineered eyelid prosthesis (IOP, Inc. Costa Mesa, CA) in the past 12 months. Two patients had upper lid reconstruction, and the remaining patients had lower lid surgery. Of the 16 patients, 2 had unilateral upper eyelid reconstruction after Merkel cell tumor removal. The remaining 14 patients had lower lid reconstruction for many different causes including thyroid-related lid retraction, maxillary hypoplasia, trauma, basal cell carcinoma, and iatrogenic, post-surgical, lower lid retraction following aesthetic lower lid surgery. For the lower lid reconstruction, a subciliary incision was utilized to obtain access to posterior lamella for proper placement of the spacer graft. This technique maintains the integrity of the conjunctiva.
Results: :
All patients have tolerated the material very well and there were no surgical complications. 21 of 22 eyelids had significant functional and aesthetic improvement. Retraction of the tarSys graft occurred in 1 eyelid. This patient had previously undergone 7 prior reconstruction procedures for cicatricial lower lid retraction deformity.
Conclusions: :
This series demonstrates that tarSysTM bioengineered eyelid prosthesis is an effective and promising option for eyelid reconstruction. Its low profile, biologic composition, flexibility while maintaining vertical support and ability to integrate into host tissue make it an attractive alternative to more invasive harvesting of autograft tissue for repair of the delicate structural anatomy of the eyelids. Further study and longer term follow up are ongoing.
Keywords: eyelid • orbit • wound healing