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Rahal A, Meller D, Manthey A, Pförtner R, Lang S, Bechrakis N, Westekemper H. Midterm results of conjunctival reconstruction with buccal mucosa and amniotic membrane after resecting ocular surface squamous neoplasia of the fornix. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:543-549. [PMID: 35940212 DOI: 10.1016/j.jcjo.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/29/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the midterm results of tumour resection with or without adjunctive therapy for ocular surface squamous neoplasia of the fornix, including conjunctival reconstruction with buccal mucosa and amniotic membrane. METHODS A retrospective case-series analysis including slit-lamp examination, photographic documentation, and biopsy results (repeated when clinical findings changed). Analysis centred on eye function, complications, additional procedures, and recurrence rate. Surgical technique included tumour resection and subsequent reconstruction of lost conjunctiva with buccal mucosa and amniotic membrane. RESULTS We included 83 affected eyes from 76 patients (mean age, 63.10 ± 14.45 years; 34 females) seen over a mean follow-up period of 26.56 ± 21.17 months. We achieved bulbus oculi salvage in 82 eyes (98.79%) and typically preserved visual acuity (mean 0.2 ± 0.5 logMAR and 0.3 ± 0.5 logMAR at presentation and last follow-up, respectively). Moreover, only 23 patients (27.71%) required corrective surgery for clinically relevant complications. The main complications included symblepharon (9.64%; n = 8), cicatricial ectropion (9.64%; n = 8), pannus (9.64%; n = 8), and corneal decompensation (8.43%; n = 7). Local tumour recurrence was seen in 23 patients (27.71%). CONCLUSIONS These midterm results confirm the efficacy of conjunctival reconstruction with amniotic membrane and buccal mucosa after resection of ocular surface squamous neoplasia from the fornix with palpebral and bulbar conjunctiva involvement. We not only achieved good tumour control and organ salvage with high levels of organ preservation but we also achieved good functional outcomes and acceptable recurrence rates. All clinically significant complications could be corrected in separate procedures.
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Affiliation(s)
- Ahmad Rahal
- From the Department of Ophthalmology, University of Duisburg-Essen, Duisburg, Germany; Department of Ophthalmology, University of Jena, Jena, Germany.
| | - Daniel Meller
- Department of Ophthalmology, University of Jena, Jena, Germany
| | - Anke Manthey
- From the Department of Ophthalmology, University of Duisburg-Essen, Duisburg, Germany
| | - Roman Pförtner
- Department of Craniomaxillofacial Surgery, Kliniken Essen Mitte, University of Duisburg-Essen, Duisburg, Germany
| | - Stefan Lang
- Department of Ear-Nose-Throat, University of Duisburg-Essen, Duisburg, Germany
| | - Nikolaos Bechrakis
- From the Department of Ophthalmology, University of Duisburg-Essen, Duisburg, Germany
| | - Henrike Westekemper
- From the Department of Ophthalmology, University of Duisburg-Essen, Duisburg, Germany
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Xu P, Gao Q, Feng X, Lou L, Zhu T, Gao C, Ye J. A biomimetic tarso-conjunctival biphasic scaffold for eyelid reconstruction in vivo. Biomater Sci 2019; 7:3373-3385. [PMID: 31233046 DOI: 10.1039/c9bm00431a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Conventional 3D porous scaffolds used as tarsal plate substitute may cause corneal irritation and conjunctival mucoid discharge, and even lead to blindness and cicatricial blepharon deformities. In this study, collagen/chitosan (Col/CS) sponges with thickness of 240 μm, 466 μm, and 724 μm were composited onto poly(propylene fumarate)-co-2-hydroxyethyl methacrylate (PPF-HEMA) polymer networks to obtain the corresponding biphasic scaffolds, which simulate the natural anatomy of posterior lamella of eyelid. These three scaffolds exhibited a porous structure with porosity of ∼90%, simulated elastic modulus, appropriate degradation rate and good biocompatibility. Composited with Col/CS sponge of difference thickness, the scaffolds induced different cellular behaviors such as proliferation, distribution and stratification, by regulating the mechanical properties cells sensed as effective modulus. In a rabbit tarso-conjunctival defect model, the grafted biphasic scaffolds promoted re-epithelization with functional regenerated conjunctiva. Hence, the biphasic composite scaffolds may be a promising substitute for tarso-conjunctival repair.
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Affiliation(s)
- Peifang Xu
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Qi Gao
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Xue Feng
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Lixia Lou
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Tiepei Zhu
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Changyou Gao
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
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Lemaître S, Lévy-Gabriel C, Desjardins L, González-Candial M, Gardrat S, Dendale R, Cassoux N, Couturaud B. Outcomes after surgical resection of lower eyelid tumors and reconstruction using a nasal chondromucosal graft and an upper eyelid myocutaneous flap. J Fr Ophtalmol 2018; 41:412-420. [PMID: 29778279 DOI: 10.1016/j.jfo.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/10/2017] [Accepted: 10/20/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Surgical excision of large malignant lower eyelid tumors may cause important full-thickness eyelid defects. The reconstruction of such defects must restore the physiologic function of the eyelid and also re-establish an acceptable aesthetic result. MATERIALS AND METHODS We report the outcomes of full-thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a nasal chondromucosal graft (coming from the ipsilateral ala of the nose) and an upper eyelid myocutaneous flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient. RESULTS A total of 25 patients were operated using this reconstruction technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo maligna). Mean duration of follow-up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and this was a basal cell carcinoma in a xeroderma pigmentosum patient. After surgery, none of the patients had lagophthalmos or ocular surface complications. Only 4 patients had a 1mm scleral show postoperatively; 3 other patients developed a small retraction of the eyelid after adjuvant radiotherapy and a 1mm scleral show occurred. CONCLUSION In malignant tumors, complete surgical excision with histological margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy of nasal chondromucosal graft and skin-muscle flap for large inferior eyelid defects provides good functional and aesthetic results.
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Affiliation(s)
- S Lemaître
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France; Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França, 17007 Girona, Spain.
| | - C Lévy-Gabriel
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - L Desjardins
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - M González-Candial
- Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França, 17007 Girona, Spain
| | - S Gardrat
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - R Dendale
- Centre de protonthérapie, Institut Curie, campus universitaire d'Orsay, bâtiment 101, 91400 Orsay, France
| | - N Cassoux
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | - B Couturaud
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
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[Results of Cutler-Beard procedure for reconstruction of extensive full thickness upper eyelid defects following tumor resection]. Ophthalmologe 2017; 113:309-13. [PMID: 26487192 DOI: 10.1007/s00347-015-0146-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Cutler-Beard bridge flap technique is an established method for reconstruction of large full thickness upper eyelid defects. The purpose of the present study was to report experiences with the surgical technique, complications and results of this cutaneoconjunctival flap procedure following tumor resection. PATIENTS AND METHODS A total of 18 patients with extensive full thickness upper eyelid defects after tumor excision underwent a Cutler-Beard procedure. Of the patients four received an additional eye bank scleral implant and one received an additional free tarsal graft from the fellow upper eyelid to enhance eyelid stability. RESULTS The Cutler-Beard bridge flap technique was surgically feasible in all patients without causing damage to the lower eyelid bridge or resulting in any infections. Out of the 13 reconstructions without additional stabilizing tissue 3 (23%) developed an upper eyelid entropion that was successfully managed using a secondary scleral implant. None of the five reconstructions using additional scleral or tarsal tissue showed an entropion of the upper eyelid. CONCLUSION The Cutler-Beard bridge flap technique, which can be combined with grafting additional stabilization tissue in defects exceeding 75% of the upper eyelid length, is a reliable method for reconstruction of large full thickness upper eyelid defects following tumor excision.
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Bindehaut-, Lid- und Orbitarekonstruktion. SPEKTRUM DER AUGENHEILKUNDE 2015. [DOI: 10.1007/s00717-015-0272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cheng JX, Zuo L, Huang XY, Cui JZ, Wu S, Du YY. Extensive full-thickness eyelid reconstruction with rotation flaps through "subcutaneous tunnel" and palatal mucosal grafts. Int J Ophthalmol 2015; 8:794-9. [PMID: 26308255 DOI: 10.3980/j.issn.2222-3959.2015.04.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/19/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions. This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining. METHODS Data from 22 eyes with extensive full-thickness eyelid defects from various causes between 2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized, leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate. RESULTS All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible. The defects were repaired completely, and the evaluations showed satisfactory function and appearance. CONCLUSION This technique is an improved single-stage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.
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Affiliation(s)
- Jian-Xia Cheng
- Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Lan Zuo
- Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xin-Yu Huang
- Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ji-Zhe Cui
- Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Shuai Wu
- Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yuan-Yuan Du
- Department of Ocular Plastic Surgery, the Second Hospital of Jilin University, Changchun 130033, Jilin Province, China
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