Purpose

To evaluate quantitative outcomes of lower eyelid retraction repair using porcine acellular dermal matrix scaffolding.

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Methods

A retrospective chart review assessed patients undergoing lower eyelid retraction repair with porcine acellular dermal matrix scaffold at a single academic institution. A transconjunctival approach was used with direct graft fixation to the tarsus underneath a conjunctival cuff to promote epithelialization of the graft on the upper edge. The primary outcomes were postoperative change in margin reflex distance 2 (MRD2), inferior scleral show (ISS), and lagophthalmos, analyzed overall and stratified by prior repair history and etiology.

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Results

87 eyelids (63 patients) were included (mean age 65.7±18.5 years, 64.4% female). The most common etiologies were prior cosmetic surgery (48.2%) and thyroid eye disease (TED, 20.0%). At mean follow-up of 13.3 months, significant improvements were observed: mean MRD2 change -1.33±1.97 mm, ISS change -1.67±1.64 mm, and lagophthalmos change -0.97±1.53 mm (p≤0.001 for all). One implant extrusion occurred; no corneal or other complications were noted. Both prior and no-prior repair groups showed significant MRD2 and ISS reduction. Across etiologic subgroups, all postoperative metrics improved with no significant between-group differences (p≥0.05).

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Conclusion

Lower eyelid retraction may result from thyroid eye disease, trauma, or surgery, including cosmetic lower eyelid procedures. Surgical correction with grafts may be required. Porcine-derived acellular dermal matrix may offer advantages over autologous grafts including no need for tissue harvesting and thus no donor site morbidity. This study shows porcine acellular dermal matrix scaffolding may be effective for lower eyelid retraction repair in both primary and revision surgery and across various etiologies including cosmetic surgery and TED. This is the largest study to quantitatively assess eyelid metrics after such repair, including stratification by etiology and prior surgical history.

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Additional Authors

First name	Last name	Base Hospital / Institution
Gillian	Folk	Shiley Eye Institute, UC San Diego
Catherine	Liu	Shiley Eye Institute, UC San Diego
Bobby	Korn	Shiley Eye Institute, UC San Diego
Don	Kikkawa	Shiley Eye Institute, UC San Diego

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