Korean J Ophthalmol.  2017 Feb;31(1):9-15. 10.3341/kjo.2017.31.1.9.

Surgical Outcomes of Porcine Acellular Dermis Graft in Anophthalmic Socket: Comparison with Oral Mucosa Graft

• Teo L
• Woo YJ
• Kim DK
• Kim CY
• Yoon JS

• KMID: 2368673
• DOI: http://doi.org/10.3341/kjo.2017.31.1.9

Abstract

PURPOSE
We describe our experience with the Permacol graft in anophthalmic socket reconstruction, and compare it to the autologous buccal mucosal graft, emphasizing the postoperative vascularization and contraction of each graft.
METHODS
This was a retrospective comparative study. We measured the time necessary for the graft surface to be completely vascularized, as well as the fornix depth of the conjunctival sac in anophthalmic patients.
RESULTS
Ten patients underwent Permacol graft reconstruction, with 44 undergoing buccal mucosal graft reconstruction. Seven eyelids (70%) in the Permacol group had a good outcome, with improvement in lower eyelid position and prosthesis retention. Nine out of 10 eyelids (90%) in this group showed complete vascularization of the graft at 2.6 ± 1.9 months postoperatively, while the grafted buccal mucosa was fully vascularized at 1.1 ± 0.3 months postoperatively (p < 0.01). Postoperative fornix depth in the Permacol group was 9.1 ± 2.2 mm, compared to 14.9 ± 4.5 mm in the buccal mucosal graft group (p < 0.01). Mean increases in fornix depth were 33.1% and 67.9% of the mean vertical length of the implanted graft.
CONCLUSIONS
The Permacol graft can be useful as spacer graft material in anophthalmic socket patients. It takes longer to vascularize, and undergoes greater graft shrinkage with time, compared to the buccal mucosal graft.

Keyword

Acellular dermis; Anophthalmos; Mouth mucosa

MeSH Terms

Acellular Dermis*
Anophthalmos
Eyelids
Humans
Lacrimal Apparatus
Mouth Mucosa*
Prosthesis Retention
Retrospective Studies
Transplants*

Figure

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  Fig. 1 The surgical procedure using the Permacol implant in anophthalmic socket reconstruction. (A) Intraoperative appearance of Permacol implant. The implant edge is sutured to the conjunctival edge. (B) External appearance of anophthalmic socket with fornix deepening sutures and retinal bolsters in place. (C) Appearance of graft at 1 week postoperatively. (D) Appearance of graft at 1 month postoperatively with superficial vascularization.

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  Fig. 2 Representative patients in preoperative (left) and postoperative (right) photographs, who underwent reconstructive surgery with the Permacol graft. Photographs of adult (A,B) and pediatric (C,D) anophthalmic socket patients.

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  Fig. 3 Conjunctivalization of the Permacol graft. (A) Good outcomes showing complete vascularization of the Permacol graft. (B) Poor vascularization of the Permacol graft at 8 months postoperatively, showing unvascularized islands.

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  Fig. 4 Comparison of preoperative (preop) and postoperative (postop) fornix depth in anophthalmic socket patients receiving Permacol and undergoing buccal mucosal graft reconstructive surgery. *p < 0.05, both groups.

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