Intraoperative crosslinking of a dermis graft for lower eyelid lenghening: first report.
Author: Arnaud Martel
Base Hospital / Institution: University Hospital of Nice, France
ePoster presentation
Abstract ID: 24-114
Purpose
Lower eyelid retraction is challenging. In France, conchal graft and dermis grafts are the most used spacers. Each of them has several disadvantages. Dermis graft is widely available and provides favorable results, although secondary retraction is often noted in late follow-up, perhaps linked to a lack of rigidity. Recent studies have shown the benefits of tarsus crosslinking in animal studies.
The author reports here the first case of intraoperative crosslinking of a dermis graft for the treatment of lower eyelid retraction.
Methods
A case presentation with surgical video is provided. A patient was reffered for a 2.5 mm lower eyelid retraction following inferior rectus muscle recession in chronic thyroid eye disease. The 3 cm x 1 cm dermis graft was harvested at the level of the iliac crest. Crosslinking was applied (10 mm Riboflavin A impregnation followed by 10 minutes of UVA therapy) by one of our residents, while lower eyelid dissection was carried out. The crosslinked graft was inserted between the retractors and the tarsus. An horizontal tightening procedure (lateral canthopexy) was also performed.
Results
At 3 months, inferior scleral show improved by 2.5 mm. No complications occured. The aesthetic result was satisfactory.
Conclusion
The case demonstrates the technical feasability of intraoperative crosslinking in oculoplastic procedures. Although attractive, there is still no evidence that a crosslinked dermis provides better results than a non-crosslinked dermis spacer. In addition, crosslinking acts by remodeling the collagen fibers. Dermis is not known to contain a lot of collagen fibers compared to autologous tarsus and conchal graft. Further studies with longer follow-up are mandatory.
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