Reconstruction of Contracted Anophthalmic Socket with Acellular Dermal Allograft

Dong-Eun Oh; Yoon-Duck Kim

doi:10.3341/jkos.2008.49.3.377

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Oh and Kim: Reconstruction of Contracted Anophthalmic Socket with Acellular Dermal Allograft

Original Article

J Korean Ophthalmol Soc 2008;49(3):377-383.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.3.377

Reconstruction of Contracted Anophthalmic Socket with Acellular Dermal Allograft

Dong-Eun Oh, M.D.¹, Yoon-Duck Kim, M.D.²

¹Department of Ophthalmology, Seoul Veterans Hospital, Seoul, Korea

²Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Yoon-Duck Kim, M.D. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3561, Fax: 82-2-3410-0074, E-mail: ydkimoph@skku.edu

Received 7 June 2007 Accepted 4 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To study the use of acellular dermal allografts for the reconstruction of contracted anophthalmic sockets.

Methods

A retrospective analysis was performed on 12 patients with contracted sockets who underwent reconstructive surgery using acellular dermal allografts from 2002 to 2006.

Results

The mean age of the patients was 44.4 years. The mean duration of conjunctival sac contracture after removal of the eyeball was 21.4 years. In 4 patients, acellular dermal allografts were used as spacer grafts to elevate the eyelids, and in 8 patients the allografts were used as a conjunctival grafting material. All patients were able to wear ocular prostheses comfortably 2.2 months after surgery with acceptable cosmesis. There were no serious complications, such as infections or graft rejections during follow-up period.

Conclusions

When used as conjunctival grafting materials and tarsal substitutes to elevate patients' eyelids, acellular dermal allografts gave cosmetically and functionally acceptable results in the surgical rehabilitation of contracted sockets.

Keywords: Acellular dermal allograft, Anophthalmic socket contracture

References

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Figure 1.

The correction of contracted socket. (A) As a tarsal substitute to elevate the eyelid. (B) As a conjunctival grafting material.

Figure 2.

Case 2. (A) Preoperative photograph showed severe socket contracture. (B) Postoperative photograph taken 1 month after the operation. We performed upper and lower conjunctival sac reconstruction using acellular dermal graft as a conjunctival grafting material. (C), (D) Postoperative photograph taken 4 months after the operation. He was able to wear the prosthesis with good cosmesis.

Figure 3.

Case 7. (A) Preoperative photograph showed inferior dystopia, lower lid entropion, and retraction in a 50-year-old woman with anophthalmos. (B) She underwent the lower eyelid reconstruction with acellular dermal graft to elevate the eyelid. Postoperative photograph 8 months after the operation. Good lower eyelid position was achieved.

Table 1.

Summary of patients

No.	Sex/ Age	Type of surgery	Cause of removal	Removal time^‡	Time to contraction after removal	Degree of contracture	Eyelid^§	Purpose of graft^Π	Type of Graft^#	Follow up (months)	Prosthesis (months)	Complication
1	M/23	Enu^*	Retinoblastoma	6	15 yrs	Moderate	L	C	A	2	Immediate	None
2	M/59	Enu	Trauma	24	Unknown	Severe	U/L	C	A	35	2	None
3	M/39	Evi^†	Trauma	26	11 yrs	Moderate	L	C	A	1	Immediate	None
4	F/30	Evi	Trauma	8	19 yrs	Mild	L	T	A	5	1	None
5	F/54	Evi	Trauma	53	6 months	Moderate	L	C	A	27	7	Delay of reepithelization
6	M/28	Enu	Trauma	7	16 yrs	Moderate	L	C	A	7	1.5	None
7	F/59	Enu	Unknown	3	54 yrs	Mild	L	T	A	40	5	Inflammation
8	M/70	Enu	Unknown	10	59 yrs	Moderate	L	C	S	14	1.5	None
9	M/22	Evi	Trauma	20	8 months	Mild	L	T	S	10	3	None
10	M/41	Enu	Trauma	24	3 yrs	Moderate	U/L	C	S	6	2	Inflammation
11	F/64	Evi	Unknown	6	54 yrs	Moderate	L	C	S	6	2	Inflammation
12	F/44	Evi	Trauma	23	3 yrs	Moderate	L	T	S	10	1	None

^* Enu=enucleation

^† Evi=evisceration

^‡ Years old

^§ U=upper, L=lower

^Π T=tarsal substitute; C=conjunctival and fornix graft

^# A=AlloDerm;^®; S=SureDerm;^®.

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