Abstract
Purpose
To report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER).
Methods
In this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0–81.0, median 13.0, last follow-up) months in all patients.
Results
At the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit.
Conclusion
In this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Lower eyelid retraction (LER) caused by cicatricial changes is a common condition in patients with Graves’ orbitopathy (GO) as well as following trauma or prior lower eyelid blepharoplasty [1,2,3]. LER with lagophthalmos potentially leads to destructive ocular surface diseases, such as exposure keratopathy, corneal ulcer, and loss of vision [4]. Anatomically, LER results from a vertical shortening of the posterior lamella [5]. The correction of LER involves graft or non-graft surgical techniques [6,7,8,9,10]. Generally, non-graft techniques including recession, tenotomy, or extirpation of the capsulopalpebral fascia and inferior tarsal muscle, are used in mild cases of LER [2, 11, 12]. Numerous autologous grafts, including auricular cartilage [13], dermis fat [14], hard-palate mucosa [11], and spacer materials, such as porous polyethylene [15,16,17], have been used for more severe cases of LER [18]. Generally, the rationale behind grafts is to prevent re-scarring and to push the lower eyelid upwards [19]. However, harvest site morbidities pose a major limitation to autologous grafts [11]. Allogenous donor grafts, such as scleral grafts, are of limited availability and generally associated with a risk of transmitting the Human Immunodeficiency Virus (HIV) or slow viruses [2].
Fascia lata (FL) is the deep fascia of the thigh transmitting mechanical forces of the musculoskeletal system of the lower extremities [20]. FL mainly consists of a collagen matrix, fibrocytes, and fibroblasts [20, 21]. Its suitability for grafting has been attributed to the relative acellularity, low nutritional demands, tensile strength, and pliability [21, 22]. Allogenous FL with similar properties to autologous FL is commercially available and avoids patient’s donation site morbidity [23]. It is prepared using low dose gamma irradiation with sterilization of microbes [23]. Due to their advantages, FL grafts have been used in different surgical specialties, including urologic [24], orthopedic [25], neuro- [26], and general surgery [27]. In 1909, Payr pioneered the use of FL in ophthalmic surgery for the correction of congenital ptosis [28]. Since then, FL has been used for the treatment of numerous ophthalmic conditions, such as orbital implant extrusion, scleromalacia perforans, cicatricial entropion, and large vertical squint angles in patients with Graves’ orbitopathy [21, 29, 30].
In this study, we evaluated the use of allogenous FL as a graft for lower eyelid elevation in patients with LER.
Material and methods
In this retrospective study, we included a consecutive series of 39 eyes of 27 patients with LER who underwent lower eyelid elevation with FL between December 2014 and May 2021. Thirty-four eyes of 23 patients with GO (87.2%), 3 eyes of 2 patients (7.7%) with iatrogenic LER following lower eyelid blepharoplasty, and 2 eyes of 2 patients (5.1%) following trauma (orbital floor fracture) were included. All patients were treated at the Department of Ophthalmology, RWTH Aachen University. Subjects included in this analysis were aged 18 years or older and were diagnosed LER due to GO, trauma, or postoperative/iatrogenic LER. Patients with involutional LER were excluded from our study. Patients with manifest vertical squint and patients following inferior rectus muscle elongation were also excluded.
Ophthalmic examinations including photographs for measurement of the inferior scleral show distance, the margin reflex distance 2 (MRD 2) [31], the palpebral fissure vertical height (PFVH), and conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0–81.0, median 13.0, last follow-up) months in all patients. For the photographs, a light source was placed 50 cm before the patient’s face and one eye was occluded. The patient was then asked to fixate the light, providing the light reflex to be in the center of the pupil. Thus, the eye was photographed in the primary position. The MRD 2 was calculated as the distance from the corneal light reflex to the center of the lower eyelid margin (Fig. 1) [31]. The PFVH was measured as the distance between the upper and lower eyelid in vertical alignment through the center of the pupil (Fig. 1). The parameters were calculated based on the assumption that the horizontal corneal diameter was 11.5 mm as reported previously (Fig. 1) [32]. Conjunctival hyperemia was evaluated according to a grading scale with six grades (0–5) introduced by McMonnies for contact lens wearers [33]. The scale considered the number, density, and tortuosity of conjunctival vessels [33].
All values were measured by two independent investigators blinded to the surgical status. Disagreements between the authors were debated and resolved by a third author.
The study adhered to the tenets of Helsinki. It was approved by the medical ethics committee of the RWTH Aachen (EK 465/21).
Surgical technique
The aim of each surgery was the reduction of LER by elevation of the lower eyelid. All procedures in this study were performed by the same experienced surgeon (K.H.). Surgery was performed under general anesthesia. Allogenous Tutoplast FL (Bess Medizintechnik GmbH, Berlin, Germany) was used as graft material. The FL graft was first rehydrated in balanced salt solution (Alcon BSS, Alcon Pharma GmbH, Freiburg, Germany). The lower eyelid was secured by retractor 4–0 silk sutures (Ethicon, Johnson and Johnson Medical GmbH, Norderstedt, Germany, Fig. 2b). After xylocaine infiltrative anesthesia to separate the lower eyelid tissue layers, the lower fornix conjunctiva was incised along its entire length at the level of the inferior edge of the tarsus (Fig. 2c). Then, the inferior edge of the conjunctiva was secured with Vicryl 8–0 (Ethicon, Johnson and Johnson Medical GmbH, Norderstedt, Germany) sutures. With the help of the traction sutures and the Vicryl sutures, the inferior edge of the conjunctiva and the lower eyelid edge can be held apart under tension. As the lower edge of the orbit should be palpable through the conjunctival incision, the conjunctiva was dissected downwards toward the orbital floor (Fig. 2c). The lower edge of the orbit was palpated for any additional scars or tension that may need to be released.
The FL graft was cut to the whole width of the eyelid with an overlap of 2–3 mm laterally and nasally. Afterward, it was sutured with Vicryl 8–0 to the exposed lower edge of the tarsus (Fig. 2d). The FL graft was then inserted into the previously prepared gap between the conjunctiva and the lower eyelid retractors (Fig. 2e). The fibers of the FL graft were transversely orientated (Fig. 2). Then, the upper and the lower incision edges of the conjunctiva were re-adapted with Vicryl sutures, which were initially put in place (Fig. 2g). This way, the FL graft was completely covered. Finally, 3 to 4 anterior–posterior penetrating traction sutures (Sulene USP 2, Serag-Wiessner, Naila, Germany) were performed below the tarsus (Fig. 2h). The Sulene sutures were tied to the skin with foam bolsters protecting the skin and avoiding a dislocation of the graft. These sutures were used to prevent scarring with a downward traction effect, and they were removed 2 weeks postoperatively. Intraoperatively, a moderate over-effect was desired.
Statistical analysis
Statistical analysis was performed using the Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, Version 25, Armonk, NY: IBM Corp.). All values are displayed as mean ± standard deviations (SD). Means for continuous variables were compared using paired T tests. Chi-square test and Fisher’s exact test were used for categorical variables. A p value of < 0.05 was considered statistically significant.
Results
Patients’ characteristics
Our study included 21 right (53.8%) and 18 left eyes of 27 patients (12 bilateral surgeries). The mean age of all patients was 56.3 ± 9.9 (34.0–71.0) years. Ten patients (37.0%) were male.
Prior to lower eyelid elevation, 8 patients (14 eyes) with GO underwent orbital decompression. Previously, bilateral recession of the lateral rectus muscles was performed in 1 patient with GO. Another patient with GO previously underwent bilateral levator lengthening by marginal myotomy. A patient with LER following trauma received a prior inferior rectus muscle adhesiolysis. The mean Clinical Activity Score [34] in the GO patients was 1.5 ± 0.7 at the time of lower eyelid elevation and was not significantly changed at the last follow-up (1.6 ± 0.6, p = 0.293).
A significant reduction of the inferior scleral show distance (0.7 ± 1.0 mm versus baseline 2.1 ± 1.1, p < 0.001), MRD 2 (6.4 ± 0.9 versus baseline 7.8 ± 1.3, p < 0.001), and PFVH (11.3 ± 1.7 versus baseline 12.8 ± 2.1, p < 0.001) occurred at the last follow-up (Table 1, Supplementary Table 1). The conjunctival hyperemia grading score was significantly reduced at the last follow-up (1.8 ± 0.7) compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was witnessed at the last follow-up. Figure 3 shows the pre- und postoperative findings of a patient undergoing lower eyelid elevation with FL.
Complications
No intraoperative complications occurred. At the first postoperative day, a case of moderate hemorrhage at the surgery site most likely due to continued factor Xa inhibitor anticoagulation was reported in a 71-year-old female patient. The hemorrhage stopped spontaneously after 30 min of moderate wound compression. No further postoperative complications occurred.
Discussion
In this study, lower eyelid elevation with FL was evaluated in 39 eyes of 27 patients with LER. Postoperatively, we found a significant reduction of the PFVH, inferior scleral show distance, and MRD 2. In addition, the conjunctival hyperemia grading score was significantly reduced at the last follow-up compared to baseline. The FL graft approximated the lower eyelid in contour and stiffness. No severe intra- or postoperative complications occurred with a mean follow-up of 25.9 ± 25.5 months. To the best of our knowledge, this is the first study addressing the outcomes of lower eyelid elevation with allogenous FL grafts.
Autogenous FL was initially used to correct LER by Flanagan and Campbell in 1981 [21]. Patients with GO, cicatricial entropium, and extruding orbital implants were included. The authors reported FL grafts to be effective and readily available. With a follow-up of 2 months to 3 years, no relevant surgery-related complications occurred [21]. However, autogenous FL graft harvesting extends the surgical procedure and leaves a scar on the thigh [11, 35]. A dose of 2 mm autogenous FL was reported by Flanagan and Campbell to yield 1 mm correction of LER (dose effect: 0.5 mm LER reduction per mm autogenous FL graft) [21]. In our study, no dose effects were calculated as the FL grafts were not fixed by sutures to the lower edge of the exposed conjunctiva nor to the capsulopalpebral fascia. Instead, the FL grafts were placed without sutures on the orbial floor to create a barrier for recurrent scarring.
In a study by Sendul et al., a lower eyelid sling technique with autologous FL resulted in a significant reduction of punctate epitheliopathy and successful lower eyelid repositioning in 10 patients with lagophthalmos due to facial paralysis [4]. No cases of exposure of the suspension material were reported. However, a patient developed postoperative wound infection at the harvest site [4]. Further complications associated with harvesting of autologous FL might include postoperative numbness, pain, hematoma, muscle herniation, superficial phlebitis, and scar formation at the harvest site [36, 37]. In contrast, allogenous FL grafts avoid harvest site morbidities [37]. To date, no relevant host reaction or absorption of the allogenous FL grafts have been reported, which minimizes the possibility of significant over- or under-correction of the LER [21, 30].
In our study, the MRD 2, PFVH, and inferior scleral show distance were measured in portrait photographs of the included patients. Generally, the MRD 2 is used to determine the amount of LER [31]. The normal average value of MRD 2 is 5.5 mm [31]. At baseline, the mean MRD 2 was 7.8 ± 1.3 mm in our cohort, and it was reduced to 6.4 ± 0.9 mm at the last follow-up. Thus, the significant reduction of MRD 2 shows the efficacy of lower eyelid elevation with FL in our study. The PFVH normally ranges between 7 and 12 mm [38]. At baseline, the mean PFVH (12.8 ± 2.1 mm) was elevated in our cohort. A significant reduction to a PFVH of 11.3 ± 1.7 mm occurred at the last follow-up. In addition, the conjunctival hyperemia score was significantly reduced at last follow-up. Conjunctival hyperemia is common in patients with dry eye disease due to lagophthalmos or GO [39].
The ideal graft for treating LER would mimic the tarsal-conjunctival tissue in pliability, resilience and thickness [40]. Previously, various techniques have been proposed for the correction of LER [11]. Non-graft techniques, such as free tenotomy or inferior retractor recession, only yielded limited success and therefore are only recommended for mild cases of LER [11]. Numerous graft materials have been used to treat LER, including auricular cartilage [13], sclera [2], dermis fat [14], and hard-palate mucosa [11]. The rationale for using grafts in the correction of LER is to lift the lower eyelid upwards and to prevent recurrent scarring due to their barrier function [19]. However, auricular cartilage is known to be stiff and rigid [41]. Therefore, its conformability on the globe is restricted [41]. Clinically, postoperative downgaze with auricular cartilage grafts might be impeded due to stiff, immobile lower eyelids [11]. Donor sclera is associated with recurrent retraction due to graft fibrosis [2]. Moreover, scleral grafts have a risk of transmitting HIV or slow viruses [2]. Acceptable results of LER correction using hard palate mucosa have been reported previously [11]. However, the principal concern of hard palate mucosa is donor site morbidity, mainly including hemorrhage, candidiasis and oro-nasal fistulae [11]. The major disadvantages of dermis fat grafts are surface keratinization and growth of hairs resulting in ocular surface complications [42].
With a mean follow-up of 25.9 ± 25.5 months, no postoperative complications, such as extrusion of the graft, scar formation, entropion or ectropion were witnessed in our study, which is attributable to the high biocompatibility of FL. To date, numerous benefits of allogenous FL grafts, such as a very low risk of infection, displacement, extrusion, harvest site morbidities or transmission of prion and viral diseases have been reported [43]. Previous histologic reports emphasize the high possibility of complete integration of FL tissue transplants into the body’s own tissue [43]. Generally, the tensile strength of the FL is particularly high in the direction of the fibers and only minimally transversely [44]. In lower eyelid elevation, the fibers of the FL graft were transversely orientated as the surgery aims to recess the lower lid retractors instead of transmitting forces.
The lack of a control group, the small sample size and the retrospective design of our study pose limitations for the analysis of lower eyelid elevation with FL. Future prospective studies are warranted to directly compare the outcomes of lower eyelid elevation with FL to those with other graft materials.
Altogether, in this case series, lower eyelid elevation with FL grafts as a spacer was associated with a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No relevant surgery-related complications occurred. Intraoperatively, the FL grafts showed a high pliability and conformability to the globe. However, future studies are needed to directly compare the outcomes of lower eyelid elevation with FL to those with other autologous or allogenous grafts and to non-graft techniques.
References
Roostaeian J, Kohan E, Tanna N, Tabit CJ, Kawamoto HK, Bradley JP (2012) Staged reconstruction of the lower eyelid following tri-lamellar injury: a case series and anatomic study. J Plast Reconstr Aesthet Surg 65(1):48–53. https://doi.org/10.1016/j.bjps.2011.07.029
Olver JM, Rose GE, Khaw PT, Collin JR (1998) Correction of lower eyelid retraction in thyroid eye disease: a randomised controlled trial of retractor tenotomy with adjuvant antimetabolite versus scleral graft. Br J Ophthalmol 82(2):174–180. https://doi.org/10.1136/bjo.82.2.174
McCord CD Jr, Ellis DS (1993) The correction of lower lid malposition following lower lid blepharoplasty. Plast Reconstr Surg 92(6):1068–1072. https://doi.org/10.1097/00006534-199311000-00011
Sendul SY, Cagatay HH, Dirim B, Demir M, Acar Z, Olgun A, Can E, Guven D (2015) Effectiveness of the lower eyelid suspension using fascia lata graft for the treatment of lagophthalmos due to facial paralysis. Biomed Res Int 2015:759793. https://doi.org/10.1155/2015/759793
Flanagan JC (1980) Retraction of the eyelids secondary to thyroid ophthalmopathy–its surgical correction with sclera and the fate of the graft. Trans Am Ophthalmol Soc 78:657–685
Gardner TA, Kennerdell JS, Buerger GF (1992) Treatment of dysthyroid lower lid retraction with autogenous tarsus transplants. Ophthalmic Plast Reconstr Surg 8(1):26–31. https://doi.org/10.1097/00002341-199203000-00004
Kersten RC, Kulwin DR, Levartovsky S, Tiradellis H, Tse DT (1990) Management of lower-lid retraction with hard-palate mucosa grafting. Arch Ophthalmol 108(9):1339–1343. https://doi.org/10.1001/archopht.1990.01070110155041
Marks MW, Argenta LC, Friedman RJ, Hall JD (1989) Conchal cartilage and composite grafts for correction of lower lid retraction. Plast Reconstr Surg 83(4):629–635. https://doi.org/10.1097/00006534-198904000-00006
Doxanas MT, Dryden RM (1981) The use of sclera in the treatment of dysthyroid eyelid retraction. Ophthalmology 88(9):887–894. https://doi.org/10.1016/s0161-6420(81)80002-4
Cooper WC (1979) The surgical management of the lid changes of Graves’ disease. Ophthalmology 86(12):2071–2080. https://doi.org/10.1016/s0161-6420(79)35287-3
Wearne MJ, Sandy C, Rose GE, Pitts J, Collin JR (2001) Autogenous hard palate mucosa: the ideal lower eyelid spacer? Br J Ophthalmol 85(10):1183–1187. https://doi.org/10.1136/bjo.85.10.1183
Goldberg RA, Lufkin R, Farahani K, Wu JC, Jesmanowicz A, Hyde JS (1994) Physiology of the lower eyelid retractors: tight linkage of the anterior capsulopalpebral fascia demonstrated using dynamic ultrafine surface coil MRI. Ophthalmic Plast Reconstr Surg 10(2):87–91
Baylis HI, Perman KI, Fett DR, Sutcliffe RT (1985) Autogenous auricular cartilage grafting for lower eyelid retraction. Ophthalmic Plast Reconstr Surg 1(1):23–27. https://doi.org/10.1097/00002341-198501000-00004
Korn BS, Kikkawa DO, Cohen SR, Hartstein M, Annunziata CC (2008) Treatment of lower eyelid malposition with dermis fat grafting. Ophthalmology 115(4):744-751.e742. https://doi.org/10.1016/j.ophtha.2007.06.039
Kim MJ, Choi YM, Kim N, Choung HK, Khwarg SI (2022) The effects of using spacer grafts on lower-eyelid retraction surgery in patients with facial nerve palsy. Eur J Ophthalmol 32(4):2072–2077. https://doi.org/10.1177/11206721211051931
de Jong-Hesse Y, Paridaens DA (2006) Correction of lower eyelid retraction with a porous polyethylene (Medpor) lower eyelid spacer–Medpor spacer in lower eyelid retraction. Klin Monbl Augenheilkd 223(7):577–582. https://doi.org/10.1055/s-2006-926508
Morton AD, Nelson C, Ikada Y, Elner VM (2000) Porous polyethylene as a spacer graft in the treatment of lower eyelid retraction. Ophthalmic Plast Reconstr Surg 16(2):146–155. https://doi.org/10.1097/00002341-200003000-00010
Patipa M (2000) The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg 106(2):438–453. https://doi.org/10.1097/00006534-200008000-00033
Kim KH, Baek JS, Lee S, Lee JH, Choi HS, Kim SJ, Jang JW (2017) Causes and Surgical Outcomes of Lower Eyelid Retraction. Korean J Ophthalmol 31(4):290–298. https://doi.org/10.3341/kjo.2016.0059
Szotek S, Dawidowicz J, Eyden B, Matysiak N, Czogalla A, Dudzik G, Leśniewicz A, Maksymowicz K (2016) Morphological features of fascia lata in relation to fascia diseases. Ultrastruct Pathol 40(6):297–310. https://doi.org/10.1080/01913123.2016.1239665
Flanagan JC, Campbell CB (1981) The use of autogenous fascia lata to correct lid and orbital deformities. Trans Am Ophthalmol Soc 79:227–242
Link MJ, Converse LD, Lanier WL (2008) A new technique for single-person fascia lata harvest. Neurosurgery 63(4 Suppl 2):359–361. https://doi.org/10.1227/01.Neu.0000327035.12333.E3
Tanji TM, Lundy DC, Minckler DS, Heuer DK, Varma R (1996) Fascia lata patch graft in glaucoma tube surgery. Ophthalmology 103(8):1309–1312. https://doi.org/10.1016/s0161-6420(96)30506-x
Kargi E, Yeşilli C, Akduman B, Babucçu O, Hoşnuter M, Mungan A (2003) Fascia lata grafts for closure of secondary urethral fistulas. Urology 62(5):928–931. https://doi.org/10.1016/j.urology.2003.07.012
Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17(9):971–980. https://doi.org/10.1053/jars.2001.28979
Thammavaram KV, Benzel E, Kesterson L (1990) Fascia lata graft as a dural substitute in neurosurgery. South Med J 83(6):634–636
de Vries Reilingh TS, Bodegom ME, van Goor H, Hartman EH, van der Wilt GJ, Bleichrodt RP (2007) Autologous tissue repair of large abdominal wall defects. Br J Surg 94(7):791–803. https://doi.org/10.1002/bjs.5817
Payr E (1909) Plastik mittels freier Faszientransplantation bei Ptosis. Deutsche Med Wochenschr 35:82
Armstrong K, McGovern VJ (1955) Scleromalacia perforans with repair grafting. Trans Ophthalmol Soc Aust 15:110–121
Prinz J, Hartmann K, Migliorini F, Hamesch K, Walter P, Fuest M, Kuerten D (2022) Elongation of the inferior rectus tendon with fascia lata graft for large vertical squint angles in patients with Graves’ orbitopathy. Graefes Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-022-05696-5
Putterman AM (2012) Margin reflex distance (MRD) 1, 2, and 3. Ophthalmic Plast Reconstr Surg 28(4):308–311. https://doi.org/10.1097/IOP.0b013e3182523b7f
Zamani M, Thyagarajan S, Olver JM (2008) Functional use of hyaluronic acid gel in lower eyelid retraction. Arch Ophthalmol 126(8):1157–1159. https://doi.org/10.1001/archopht.126.8.1157
McMonnies CW, Chapman-Davies A (1987) Assessment of conjunctival hyperemia in contact lens wearers. Part I. Am J Optom Physiol Opt 64(4):246–250. https://doi.org/10.1097/00006324-198704000-00003
Mourits M, Koornneef L, Wiersinga W, Prummel M, Berghout A, Van Der Gaag R (1989) Clinical criteria for the assessment of disease activity in Graves’ ophthalmopathy: a novel approach. Br J Ophthalmol 73(8):639–644
Wheatcroft SM, Vardy SJ, Tyers AG (1997) Complications of fascia lata harvesting for ptosis surgery. Br J Ophthalmol 81(7):581–583. https://doi.org/10.1136/bjo.81.7.581
Naugle TC Jr (1998) Complications of fascia lata harvesting for ptosis surgery. Br J Ophthalmol 82(3):333–334. https://doi.org/10.1136/bjo.82.3.332c
Silan F, Consiglio F, Dell’Antonia F, Montagner G, Trojan D, Berna G (2020) Cryopreserved fascia lata allograft use in surgical facial reanimation: a retrospective study of seven cases. Maxillofac Plast Reconstr Surg 42(1):2. https://doi.org/10.1186/s40902-020-0246-9
Zoumalan CI, Lisman RD (2010) Evaluation and management of unilateral ptosis and avoiding contralateral ptosis. Aesthet Surg J 30(3):320–328. https://doi.org/10.1177/1090820x10374108
Gupta A, Sadeghi PB, Akpek EK (2009) Occult thyroid eye disease in patients presenting with dry eye symptoms. Am J Ophthalmol 147(5):919–923. https://doi.org/10.1016/j.ajo.2008.12.007
Fay AM, Pieroth L, Rubin PA (2001) An animal model of lower eyelid spacer grafting with acellular dermis. Ophthalmic Plast Reconstr Surg 17(4):270–275. https://doi.org/10.1097/00002341-200107000-00006
Sullivan SA, Dailey RA (2003) Graft contraction: a comparison of acellular dermis versus hard palate mucosa in lower eyelid surgery. Ophthalmic Plast Reconstr Surg 19(1):14–24. https://doi.org/10.1097/01.Iop.0000040678.19893.F7
Bosniak SL (1990) Complications of dermis-fat orbital implantation. Adv Ophthalmic Plast Reconstr Surg 8:170–181
Jang YJ, Wang JH, Sinha V, Song HM, Lee BJ (2007) Tutoplast-processed fascia lata for dorsal augmentation in rhinoplasty. Otolaryngol Head Neck Surg 137(1):88–92. https://doi.org/10.1016/j.otohns.2007.01.009
Otsuka S, Yakura T, Ohmichi Y, Ohmichi M, Naito M, Nakano T, Kawakami Y (2018) Site specificity of mechanical and structural properties of human fascia lata and their gender differences: A cadaveric study. J Biomech 77:69–75. https://doi.org/10.1016/j.jbiomech.2018.06.018
Funding
Open Access funding enabled and organized by Projekt DEAL. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
Conceptualization, K. Hartmann, D. Kuerten and J. Prinz; methodology, J. Prinz and M. Fuest; validation, P. Walter and F. Migliorini; formal analysis, J. Prinz, K. Hamesch, and F. Migliorini; writing—original draft preparation, J. Prinz; visualization, J. Prinz, M. Fuest; supervision, K. Hartmann, D. Kuerten, P. Walter; All authors have read and agreed to the published version of the manuscript. All authors read and reviewed the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the RWTH Aachen (EK 465/21).
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Prinz, J., Hartmann, K., Migliorini, F. et al. Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction. Int Ophthalmol 43, 4729–4737 (2023). https://doi.org/10.1007/s10792-023-02873-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-023-02873-1