Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms.

BACKGROUND: Upper eyelid ectropion occurs as a post-blepharoplasty complication or involution change, and it causes dry eye symptoms that cannot be resolved with conservative management. OBJECTIVES: The aim of this study is to describe the authors' surgical technique of anatomical correction of upper eyelid ectropion, including tarsal scoring incision. METHODS: The technique involves the following 4 steps: (1) adhesiolysis at the preaponeurotic layer; (2) undermining and redraping of the pretarsal flap in a pretarsal plane; (3) optional, partial thickness tarsal scoring incision over the central two-thirds; and (4) downward repositioning of the pretarsal flap and lower fixation to the tarsus. Outcomes were assessed based on the position of eyelid margin and the improvement of the dry eye symptoms. RESULTS: A retrospective review of 54 cases of patients who underwent ectropion correction, including tarsal scoring incision, was performed. The eyelid margin was well positioned in 51 patients (94.4%). Of the 32 patients involved in the study assessed with the 7-point Patient Global Impression of Improvement, 29 (90.6%) reported the resolution of dry eye symptoms. Furthermore, in the 22 patients assessed with the Ocular Surface Disease Index, the mean score significantly decreased from 43.2 ±â€…24.1 before surgery to 29.8 ±â€…23.3 (P = 0.006) after surgery. CONCLUSIONS: The combination of partial-thickness tarsal plate scoring and lower flap redraping surgical techniques resolved the upper eyelid ectropion, reducing the dry eye symptoms.

Osteoconductivity of porous polyethylene in human skull.

PURPOSE: Recently, biomaterials have been generally used in reconstruction of a bony defect or augmentation of the facial skeleton. Medpor implants in vivo in animal models showed both soft tissue and bony ingrowth into its pores and have been widely accepted to have an osteoconduction activity. However, in an in vivo study in humans, there was no definite evidence of bony ingrowth into the pores of Medpor. This study examined the osteoconductivity of Medpor in human vivo. METHODS: We gained a total of 24 Medpor blocks when removing a distraction device in 11 patients with craniosynostosis. The Medpor blocks were used for secure placement of the distraction device. The blocks were taken out after distraction and consolidation periods. The surface of Medpor in contact with the bone was histologically examined to confirm the osteogenic activity. RESULTS: There was no evidence of osteoconduction in all 24 specimens. The mean total duration of implantation was 2.5 months. CONCLUSIONS: In human vivo, implantation of a porous polyethylene implant is thought to have no osteogenetic effect through osteoconductive activity even in young children.