EXTENDED REPORT

The use of porous polyethylene (Medpor) lower eyelid spacers in lid heightening and stabilisation

J Tan¹, J Olver², M Wright³, R Maini², C Neoh¹ and A J Dickinson¹

¹ Royal Victoria Infirmary, Newcastle upon Tyne, UK
² Western Eye Hospital, London, UK
³ Velindre NHS Trust, Cardiff, UK

Correspondence to:
Correspondence to:
A Jane Dickinson
Eye Department, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; Jane.Dickinson{at}ncl.ac.uk

Background/aims: The management of lower eyelid retraction can be challenging, and established techniques to correct it are not always successful. Previous reports have suggested a role for the ultrathin high density porous polyethylene lower eyelid spacer (Medpor LES) in such patients. The authors report the experience of three surgeons implanting Medpor LES over 1 year, and ascertain whether such implants are a safe and effective alternative to autogenous spacers.

Methods: A prospective, interventional, non-comparative case series of consecutive patients. Surgical indications for Medpor LES were noted. Preoperative and postoperative lower marginal reflex distance (L-MRD), vertical palpebral aperture (PA), lagophthalmos, and scleral show inferior to the limbus (LSS) were recorded, together with major and minor complications.

Results: 32 patients (35 eyelids) had a Medpor LES inserted, 22/32 under local anaesthetic, and nine with adjunctive procedures. Mean follow up was 22 months (range 15–28 months). The Medpor LES was effective in reducing the palpebral aperture (p<0.001) and lagophthalmos (p = 0.04) and raising the lower eyelid height by reducing both L-MRD (p = 0.006) and LSS (p<0.001). However there were major complications in 7/32 patients and minor complications in 8/32, most requiring further surgery. Final outcome was good in 24/35 eyelids and satisfactory in 5/35.

Conclusions: Despite a good or satisfactory final outcome in the majority of patients, the value of this technique is limited by complications, and should be reserved for those unsuitable for safer techniques.

Abbreviations: LES, lower eyelid spacer; L-MRD, lower marginal reflex distance; LSS, scleral show inferior to the limbus; PA, palpebral aperture; PESS, post-enucleation socket syndrome

Keywords: Medpor; porous polyethylene; lower eyelid spacer; implant

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eLetters:

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A Perspective on Porous Polyethylene Lower Lid Spacers

Mandeep S. Bajaj, et al.

BJO Online, 28 Sep 2004 [Full text]

Response to Professor Bajaj

A Jane Dickinson, et al.

BJO Online, 4 Jan 2005 [Full text]