Polytetrafluoroethylene as an Interpositional Graft Material for the Correction of Lower Eyelid Retraction

doi:10.1016/S0161-6420(89)32875-2

Ophthalmology

Volume 96, Issue 4, April 1989, Pages 419-423

https://doi.org/10.1016/S0161-6420(89)32875-2 Get rights and content

Abstract

Polytetrafluoroethylene (PTFE), a nonantigenic, autoclavable, inert, woven synthetic graft material was used to correct ten lower eyelids with retraction secondary to either thyroid disease (7 eyelids) or surgically repaired maxillofacial trauma (3 eyelids). The material was well tolerated for postoperative periods ranging from 10 to 26 months. In two eyelids, a portion of the PTFE was removed to treat eyelid thickening and an infected meibomian gland. Results of histopathologic examination of the graft showed minimal inflammation and capillary and connective ingrowth into the graft matrix as well as a dense fibrous capsule around the graft. In selected cases, PTFE may be an acceptable substitute for other graft materials used in oculoplastic surgery.

References (14)

MM Cohen et al.
Retraction of the lower eyelid
Neurology
(1979)
JS Crawford et al.
The use of bank sclera to correct lid retraction
Can J Ophthalmol
(1976)
RR Waller
Eyelid malpositions in Graves' ophthalmopathy
Trans Am Ophthalmol Soc
(1982)
AM Putterman
Surgical treatment of dysthyroid eyelid retraction and orbital fat hernia
Otolaryng Clin North Am
(1980)
MT Doxanas et al.
The use of sclera in the treatment of dysthyroid eyelid retraction
Ophthalmology
(1981)

There are more references available in the full text version of this article.

Cited by (55)

Modified auricular cartilage sling for paralytic ectropion
2015, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
While these techniques are simple, many patients experience recurrence.3,14 To better support the paralytic eyelid, biological materials such as preserved sclera,17 hard palate mucosa,18 some lamella grafts8–11 and artificial materials such as polytetrafluoroethylene19 and porous polyethylene (Medpor)20 have been used as spacers. They have been used primarily for lower eyelid retraction, are not suitable for total eyelid suspension but for support of the posterior lamella.
To evaluate the outcomes of a modified auricular cartilage sling for paralytic ectropion.
We treated 17 eyelids of 17 patients (average 67 years old) with an auricular cartilage sling between 2004 and 2012. All patients had paralytic ectropion with lower eyelid ptosis. Cartilage was harvested via an incision just inside the anterior rim of the helix. Skin incisions were made at the subciliary, medial and lateral canthal regions. The auricular cartilage graft was sutured to the medial canthal tendon medially, lateral orbital rim laterally, inferior tarsus superiorly, and lower eyelid retractors inferiorly. Average follow-up period was 40 months (range 16–60 months).
The median L-MRD (mm) was improved from 8.4 preoperatively (interquartile range 7.5–8.9) to 5.2 postoperatively (4.8–5.3). The median lagophthalmos (mm) was improved from 5.8 preoperatively (4.7–7.0) to 2.2 postoperatively (1.6–2.6). 16 patients had corneal exposure preoperatively and this resolved completely in 12 patients. All patients experienced good anatomical and functional results with relief of their preoperative pain/discomfort symptoms without complications. No patients required reoperation and none experienced infection, exposure of the cartilage graft, or recurrence of lower eyelid malpositions. Postoperatively, all lower eyelids moved downward with down-gaze. The auricular scar left no significant cosmetic deformity.
The modified auricular cartilage sling with 4 point fixation for paralytic ectropion appears to maintain normal eyelid mobility with down-gaze and avoids the problem of lower eyelid fixation.
Correction of lower lid retraction using TarSys bioengineered grafts for graves ophthalmopathy
2013, American Journal of Ophthalmology
Citation Excerpt :
Therefore, the search for alternative graft materials is continuously developing. High-density porous polyethylene, a biointegratable implant material, can be used for lower eyelid retraction with a good and satisfactory final outcome in the majority of patients.23 But the high rate of complications such as implant extrusion/exposure, poor lid motility, and ectropion limits the value of this technique.12,24,25
To investigate the efficacy of decellularized porcine-derived membrane (tarSys; IOP Inc), a bioengineered eyelid spacer graft, for lower lid retraction correction in patients with Graves ophthalmopathy.
Retrospective observational case series study.
This was a retrospective review of patients with Graves ophthalmopathy undergoing lower eyelid retraction surgery using decellularized porcine-derived membrane bioengineered eyelid spacer grafts from 2008 through 2011. Outcome measures included lower eyelid height (measured from the corneal light reflex to the lower eyelid margin, or marginal reflex distance-2 [MRD₂]), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed for functional and cosmetic outcome.
A total of 32 Graves patients and 37 eyelids underwent lower eyelid retraction surgery using decellularized porcine-derived membrane. There were 10 male and 22 female patients with mean age of 41.8 ± 8.6 years. Mean improvement in MRD₂ was 1.4 ± 0.4 mm. Mean reduction of lagophthalmos was 1.3 ± 0.4 mm. There are statistically significant differences between preoperative and postoperative MRD₂ and lagophthalmos (paired t test, both P < .0001). No evidence of infection and corneal erosion was noted and none of the patients needed further surgeries. Prolonged lower lid swelling and slight puffy appearance were noted for 6 patients. The swelling and puffy appearance resolved completely 3 months after surgery. Conjunctival granuloma formation was found in 1 patient. The cosmetic result was satisfactory in all cases.
Decellularized porcine-derived membrane, a bioengineered graft, is effective for the management of lower lid retraction in patients with Graves ophthalmopathy. It can offer an alternate graft for eyelid reconstruction.
Subperiosteal Midface Lift with or without a Hard Palate Mucosal Graft for Correction of Lower Eyelid Retraction
2006, Ophthalmology
To compare functional and surgical outcomes of a subperiosteal midface lift with and without the placement of a hard palate mucosal graft (HPMG) in patients with lower eyelid retraction.
Retrospective, comparative, interventional case series.
Thirty-four patients with lower eyelid retractions who underwent surgery at the Jules Stein Eye Institute in a 5-year period.
Medical record review of all patients who underwent surgery for lower eyelid retraction by a subperiosteal midface lift with or without an HPMG. Preoperative and postoperative digital photographs were taken in all patients.
Change in margin reflex distance 2 (MRD₂), measured from the pupillary margin to the upper margin of the lower eyelid; patient discomfort; and surgical complications.
Thirty-four patients (20 female; mean age, 64 years) participated in the study; 11 underwent bilateral surgery, with overall 43 surgeries performed. Eighteen patients (42%) had lower eyelid retraction secondary to previous transcutaneous lower eyelid blepharoplasty. Postoperatively, patients attained a better lower eyelid position, with improvement of lower eyelid height of 1.4 mm (P<0.001, 1-sample t test). Patients operated using an HPMG (12 surgeries) achieved a greater reduction in MRD₂ postoperatively as compared with patients operated by subperiosteal midface lift alone (31 surgeries; 2.2 mm vs. 1.1 mm, respectively; P = 0.02, Wilcoxon Mann–Whitney). One patient needed reoperation secondary to symptomatic lower eyelid retraction postoperatively.
The subperiosteal midface lift is effective in correction of lower eyelid retraction of various causes. The use of an HPMG spacer may enhance surgical outcomes and results in a better lower eyelid position.
Diagnosis and management of thyroid orbitopathy
2005, Otolaryngologic Clinics of North America
Citation Excerpt :
Lower eyelid retraction has traditionally been treated with placement of spacer grafts. Ear cartilage, hard palate, human acellular dermis, polytetrafluoroethylene, and porous polyethylene spacers have been described and are commonly used [123–127]. Hard palate grafting has been shown to have less postoperative contraction than acellular dermis [128]; the main disadvantage to this otherwise successful technique is potential donor site complications [129].
Implants and spacers for paralytic ectropion: Literature review and assessment of a thin-profile porous polyethylene implant
2023, Indian Journal of Ophthalmology
The effects of using spacer grafts on lower-eyelid retraction surgery in patients with facial nerve palsy
2022, European Journal of Ophthalmology

View all citing articles on Scopus

: Presented at the American Academy of Ophthalmology Annual Meeting, Las Vegas, October 1988.

View full text

Polytetrafluoroethylene as an Interpositional Graft Material for the Correction of Lower Eyelid Retraction

Abstract

Retraction of the lower eyelid

Neurology

The use of bank sclera to correct lid retraction

Can J Ophthalmol

Eyelid malpositions in Graves' ophthalmopathy

Trans Am Ophthalmol Soc

Surgical treatment of dysthyroid eyelid retraction and orbital fat hernia

Otolaryng Clin North Am

The use of sclera in the treatment of dysthyroid eyelid retraction

Ophthalmology