Lower Eyelid Retraction Repair with Resorbable Polydioxanone Implants

Long-term stability of transconjunctival midface lift surgery for postblepharoplasty lower eyelid retraction

Lower eyelid retraction occurring as a complication of lower eyelid blepharoplasty may give rise to symptoms of exposure keratitis as well as cosmetic considerations. This retrospective longitudinal study describes our clinical experience with 74 patients with bilateral lower eyelid retraction postblepharoplasty (148 eyes) undergoing a transconjunctival subperiosteal midface lift with the implantation of a hard palate spacer graft over the period 2002 to 2019. All patients had a forced-up traction test result of less than or equal to 2 mm, indicating a significant fibrosis of the middle lamellae. Margin reflex distances (MRD2) were examined at follow-up visits scheduled for 2 weeks, 1 month, and 1, 3, 6, 9, and 12 years. Mean follow-up duration was ± 102 months (range 6 to 144 months). In all patients, MRD2 varied up until 1-year postsurgery and stabilized thereafter. Last follow-up MRD2 values indicated retraction improvements of 1.4, 2.4, and 3.2 mm, respectively, for those with mild: MRD2 6.3 mm [5.5 - 6.6], moderate: 7.0 mm [6.7 - 7.8], and severe retraction: 8.5 mm [7.9 - 9]. This improvement was statistically significant in patients with severe baseline retraction (p = 0.04). This approach proved to be safe and functional, and cosmetic results were excellent and remained stable over time.

Cheek-midface lifting with lateral canthoplasy for the repair of complex iatrogenic lower eyelid ectropion

PURPOSE

To assess the efficiency and safety of cheek-midface lifting for the ophthalmoplastic reconstructive surgical repair of cicatricial lower eyelid malpositions after previously failed surgery.

METHODS

In two ophthalmoplastic clinics, 14 eyelids of 13 patients underwent transconjunctival cheek-midface lifting. In a retrospective audit, changes in margin-reflex distance 2 (MRD2), snap-back test, the position of the eyelid after surgery including improving of the presurgical scleral show, the overall patient's satisfaction as well as complications after surgery were recorded.

RESULTS

Following transconjunctival cheek-midface lifting, there was a significant improvement of MRD2, snap-back test, and the scleral show (p < 0.001, respectively). However, in three patients the scleral show persisted despite improved MRD2. All patients were satisfied with the results of the surgery. No post-surgical long-term complications were developed.

CONCLUSION

Cheek-midface lifting can be a useful technique in severe cicatricial lower eyelid ectropion after previously failed surgery and is a safe and effective reconstructive method for ophthalmic surgeons with good cosmetical results and little postoperative long-term complications.

Autologous dermis graft versus conchal cartilage graft for managing lower eyelid retraction: A comparative study

PURPOSE

Lower eyelid management is challenging. The conchal cartilage is often considered a spacer of choice for treating lower eyelid retraction. However, dermis graft has also recently been shown to be a viable spacer. The aim of this study was to compare the efficacy of dermis graft to that of conchal cartilage graft in this indication.

METHODS

A retrospective comparative study was conducted in patients who underwent lower eyelid lengthening with autologous dermis graft (group 1) or autologous conchal cartilage graft (group 2). The main outcome measure was the reduction in inferior scleral show (ISS) assessed by three independent masked surgeons. Secondary outcome measures was the assessment of lagophthalmos and corneal keratitis. Complications were also recorded.

RESULTS

Twenty-five eyelids of 23 patients were included: 11 and 14 eyelids, respectively in group 1 (dermis graft) and group 2 (conchal cartilage graft). Patient mean follow-up was 12.3 (±12.5) and 7.1 (±7.7) months, respectively. No statistical differences in postoperative ISS reduction, lagophthalmos and exposure keratitis was observed (p = 0.540, p = 0.946, p = 0.934, respectively). Three patients experienced a grade I Clavien-Dindo complication in group 1 and one patient experienced a grade II complication in group 2 (p = 0.540).

CONCLUSION

Autologous dermis grafts and conchal cartilage grafts provide favorable outcomes without major complications.