Skip to main content

Advertisement

SpringerLink
Log in

The histopathological findings in excised upper eyelids of patients with dermatochalasis following collagen cross-linking treatment

  • Oculoplastics and Orbit
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the histopathological effects of collagen cross-linking (CCL) on excised skin samples of patients undergoing upper eyelid blepharoplasty due to dermatochalasis.

Methods

This study examined 74 excised eyelid skin samples from 37 dermatochalasis patients. Following an upper eyelid blepharoplasty, CCL with hypotonic riboflavin (0.1%) was applied. Both treated (right eyelid, CCL group) and untreated eyelid specimen (left eyelid, non-CCL group) sections were stained with hematoxylin–eosin and Masson’s trichrome. The sections were evaluated for the following parameters: the collagen status (parallel, oblique, and perpendicular), the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers.

Results

There were no statistically significant differences in the collagen status, the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers between the CCL and non-CCL groups (p > 0.05 for all). Although the lack of statistically significant differences, the structure of the treated eyelid collagen fibers was more parallel in 48% of the participants than in the untreated ones. For male patients, a statistically significant shorter distance between collagen fibers was observed in the CCL group (8.05 ± 2.04 µm) compared to the non-CCL group (9.97 ± 2.33 µm) (p = 0.042).

Conclusion

In this study, more parallel collagen structures and tightly packed collagen fibers were detected in eyelid samples following CCL treatment. The authors note that the results of this study may be promising for further research, so the effect of CCL therapy on the eyelid may be an interesting subject for the treatment of non-severe or surgically inadequately corrected dermatochalasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. McCullough JL, Kelly KM (2006) Prevention and treatment of skin aging. Ann N Y Acad Sci 1067:323–331

    Article  Google Scholar 

  2. Norman RA (2003) Geriatric dermatology. Dermatol Ther 16:260–268

    Article  Google Scholar 

  3. Pontius AT, Smith PW (2011) An antiaging and regenerative medicine approach to optimal skin health. Facial Plast Surg 27:29–34

    Article  CAS  Google Scholar 

  4. Turkcu UO, Yuksel N, Akcay E et al (2020) Assessment of COL1A1 and MMP9 expression in patients with dermatochalasis. Int Ophthalmol 40:1987–1992

    Article  Google Scholar 

  5. DeBacker CM, Putterman AM, Zhou L et al (1998) Age-related changes in type-I collagen synthesis in human eyelid skin. Ophthalmic Plast Reconstr Surg 14:13–16

    Article  CAS  Google Scholar 

  6. Karnaz A, Katircioglu YA, Ozdemir ES et al (2018) The histopathological findings of patients who underwent blepharoplasty due to dermatochalasis. Semin Ophthalmol 33:407–411

    Article  Google Scholar 

  7. Nagi KS, Carlson JA, Wladis EJ (2011) Histologic assessment of dermatochalasis: elastolysis and lymphostasis are fundamental and interrelated findings. Ophthalmology 118:1205–1210

    Article  Google Scholar 

  8. DeAngelis DD, Carter SR, Seiff SR (2002) Dermatochalasis. Int Ophthalmol Clin 42:89–101

    Article  Google Scholar 

  9. Kobashi H, Rong SS (2017) Corneal collagen cross-linking for keratoconus: systematic review. Biomed Res Int 2017:8145651

    Article  Google Scholar 

  10. Sorkin N, Varssano D (2014) Corneal collagen crosslinking: a systematic review. Ophthalmologica 232:10–27

    Article  CAS  Google Scholar 

  11. Wang Q, Harasymowycz P (2016) Collagen cross-linking for late-onset bleb leakage: 1-year results. J Glaucoma 25:e273-276

    Article  Google Scholar 

  12. DeParis SW, Zhu AY, Majumdar S et al (2019) Effects of collagen crosslinking on porcine and human tarsal plate. BMC Ophthalmol 19:255

    Article  CAS  Google Scholar 

  13. Ugradar S, Le A, Lesgart M et al (2019) Biomechanical and morphologic effects of collagen cross-linking in human tarsus. Transl Vis Sci Technol 8:25

    Article  Google Scholar 

  14. Eklouh-Molinier C, Happillon T, Bouland N et al (2015) Investigating the relationship between changes in collagen fiber orientation during skin aging and collagen/water interactions by polarized-FTIR microimaging. Analyst 140:6260–6268

    Article  CAS  Google Scholar 

  15. Hass AN, Penne RB, Stefanyszyn MA et al (2004) Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophthalmic Plast Reconstr Surg 20:426–32

    Article  Google Scholar 

  16. Kappen IFPM, Nguyen DT, Vos A et al (2018) Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: case report and review of the literature. Arch Plast Surg 45:384–387

    Article  Google Scholar 

  17. Guinot C, Malvy DJ, Ambroisine L et al (2002) Relative contribution of intrinsic vs extrinsic factors to skin aging as determined by a validated skin age score. Arch Dermatol 138:1454–1460

    Article  Google Scholar 

  18. Damasceno RW, Avgitidou G, Belfort R Jr et al (2015) Eyelid aging: pathophysiology and clinical management. Arq Bras Oftalmol 78:328–331

    PubMed  Google Scholar 

  19. Akella SS, Liu J, Miao Y et al (2021) Collagen structural changes in rat tarsus after crosslinking. Transl Vis Sci Technol 10:3

    Article  Google Scholar 

  20. Shuster S, Black MM, McVitie E (1975) The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol 93:639–643

    Article  CAS  Google Scholar 

  21. Smith TM, Suzuki S, Cronin BG et al (2018) Photochemically induced crosslinking of tarsal collagen as a treatment for eyelid laxity: assessing potentiality in animal tissue. Ophthalmic Plast Reconstr Surg 34:477–482

    Article  CAS  Google Scholar 

  22. Wollensak G, Wilsch M, Spoerl E et al (2004) Collagen fiber diameter in the rabbit cornea after collagen crosslinking by riboflavin/UVA. Cornea 23:503–507

    Article  Google Scholar 

  23. Nakayasu K, Tanaka M, Konomi H et al (1986) Distribution of types I, II, III, IV and V collagen in normal and keratoconus corneas. Ophthalmic Res 18:1–10

    Article  CAS  Google Scholar 

  24. Milz S, Neufang J, Higashiyama I et al (2005) An immunohistochemical study of the extracellular matrix of the tarsal plate in the upper eyelid in human beings. J Anat 206:37–45

    Article  CAS  Google Scholar 

  25. Woo JH, Iyer JV, Lim L et al (2017) Conventional versus accelerated collagen cross-linking for keratoconus: a comparison of visual, refractive, topographic and biomechanical outcomes. Open Ophthalmol J 11:262–272

    Article  CAS  Google Scholar 

  26. Ugradar S, Karlin J, Le A et al (2020) photochemical collagen cross-linking reverses elastase-ınduced mechanical degradation of upper eyelid tarsus. Ophthalmic Plast Reconstr Surg 36:562–565

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmology Department, Arnavutkoy State Hospital, Istanbul, Turkey

    Ali Mert Kocer

  2. Ophthalmology Department, Ankara Ulucanlar Eye Training and Research Hospital, University of Health Science, Ankara, Turkey

    Emine Malkoc Sen & Sule Yenigun

  3. Pathology Department, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey

    Muzaffer Caydere & Sema Hucumenoglu

Authors
  1. Ali Mert Kocer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emine Malkoc Sen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muzaffer Caydere
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sule Yenigun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sema Hucumenoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali Mert Kocer.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ankara Training and Research Hospital and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kocer, A.M., Sen, E.M., Caydere, M. et al. The histopathological findings in excised upper eyelids of patients with dermatochalasis following collagen cross-linking treatment. Graefes Arch Clin Exp Ophthalmol 260, 2737–2743 (2022). https://doi.org/10.1007/s00417-022-05629-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-022-05629-2

Keywords

Search

Navigation