Purpose

Correction of lower eyelid retraction may involve the use of a surgically implanted material to augment the posterior lamella. Options include autologous, alloplastic or xenograft materials. While autologous materials are generally preferable, in certain circumstances it may not be feasible to obtain them. The porcine decellularized membrane was introduced in 2007 for the correction of lower eyelid retraction. A review of the literature revealed two case reports describing the use of this implant, and three case reports describing implant associated inflammatory reaction. We undertook a study to determine the longterm efficacy of the porcine decellularized membrane graft for correction of lower eyelid retraction.

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Methods

A retrospective study was performed, identifying cases of lower eyelid retraction surgery utilizing this spacer graft, by a single surgeon, from 2016-2022. Preoperative and postoperative inferior scleral show, average improvement of inferior scleral show, median time of follow up were measured. Success was judged by improvement of inferior scleral show and/or subjective improvement of preoperative symptoms leading to surgery. Minor complications were defined as those requiring attention in a clinic setting, and major complications were defined as any complication requiring surgical intervention.

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Results

We identified 122 procedures across 82 patients during the study period. The average spacer graft dimensions were 26.3mm by 7.5mm. The average preoperative inferior scleral show was 2.8mm and the average postoperative inferior scleral show was 0.4mm (average correction: 2.4mm; median follow-up: 52 days). Lower eyelid retraction was successfully corrected in 121 of 122 procedures (99.1%), as evidenced by improvement of postoperative inferior scleral show and/or subjective improvement of symptoms. Three patients developed pyogenic granuloma, requiring excision in the office with local anesthesia. Three patients developed implant related inflammatory reaction, responding to conservative management. One patient developed bilateral granulomatous inflammation one month after surgery, requiring a return to the operating room for surgical debulking.

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Conclusion

To our knowledge, this is the first study evaluating the efficacy of the porcine decellularized membrane spacer graft for correction of lower eyelid retraction. In our study, patients experienced an average correction of 2.4mm of inferior scleral show. The incidence of major complications requiring a return to the operating room was 1.6%. Thus, porcine decellularized membrane is a viable alternative material for the correction of lower eyelid retraction, when it is not feasible to use autologous material.

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Additional Authors

First name	Last name	Base Hospital / Institution
David	Mang	Oculoplastic Consultants of Arizona
Alexander	Chen	Oculoplastic Consultants of Arizona

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