Abstract
Purpose :
To explore cosmetic and functional outcomes of a novel technique called Cerclage Periocular Reconstruction (CPR) lift,
where SMAS support is applied to reconstruction of complex periocular defects involving the eyelid, medial/lateral canthi and cheek. The proposed benefits of this technique were to improve patient cosmesis and reduce post-operative complications requiring re-operation.
Methods :
In this retrospective study, conducted at Penn State Eye Center, patients who underwent CPR lift for medial and lateral canthal defects, were evaluated via chart review for post-surgical outcomes and complications. In this technique, a 4-0 Monocryl or 4-0 PDS suture was used to secure the superficial SMAS in a purse string fashion, about 0.5-1cm from the margin of subcutaneous undermining, which was then aligned along the desired axis of advancement and anchored to the periosteum or deep facial tissues of the medial or lateral canthus. Patients were evaluated at post-operative months 1 and 3. Outcome measures included lid malposition, flap necrosis and the extent of ocular surface disease.
Results :
Six patients with medial and lateral canthal eyelid defects that were repaired with the CPR technique were seen at post-operative months 1 and 3. All patients maintained an acceptable cosmetic result at 3 months post-operatively as assessed by direct patient questioning. On chart review, one patient (16.7%) developed a mild lower lid ectropion at post-operative month 1, and no patients required further operative intervention. There was no evidence of poor lid closure, exposure keratopathy or flap necrosis in any of these surgical patients.
Conclusions :
CPR lift technique is a promising surgical technique for reconstruction of complex periocular defects involving medial/lateral canthal areas, as it maintains the natural contour of the canthi while still achieving an acceptable cosmetic result. This retrospective chart review suggests that patients maintain appropriate post-operative lid positioning without development of exposure keratopathy. CPR lift can reduce the extent of subcutaneous dissection, which can lead to a reduction in recovery time, decrease the risk of hematoma development and reduce post-operative sequelae. Further research is certainly needed with a larger sample size of patients undergoing the CPR technique in a randomized control study comparing current standard surgical methods.
This is a 2020 ARVO Annual Meeting abstract.