Permacol in eyelid reconstruction -- a novel use.

BACKGROUND: Reconstruction of a full-thickness lower eyelid defect is not an uncommon procedure and requires repair of both the anterior and posterior lamella. The modified Hughes procedure is commonly used for large defects, however this requires a second procedure and since the flap must be left in place for at least 3 weeks prior to the second-stage separation, it is not suitable for patients with only eyes or of amblyogenic age. In such situations, a free tarsoconjunctival graft from the opposite upper eyelid or a mucoperiosteal graft from the hard palate is more appropriate. These have the advantage of being autologous tissue with excellent recipient tolerance, however, they are not without drawbacks, including donor site scarring, limited availability and prolonged operating time. In order to avoid donor-site morbidity, several substitutes on the market can be used to replace autologous grafts. Permacol is a relatively new biomaterial made from acellular cross-linked porcine dermal collagen with a structural architecture very similar to that of human dermis. METHODS: The authors present the first report of the use of Permacol to replace tarsus in the reconstruction of a full-thickness lower eyelid defect. RESULTS: Permacol seems to be far superior to other commercially available tissue substitutes because of its increased tensile strength, rigidity, durability, predictability of structure and robust behaviour. It is well incorporated by the body, and it serves as an excellent matrix for tissue ingrowth. CONCLUSION: We feel it is a very good autologous graft substitute in eyelid reconstructive surgery and achieved satisfactory functional and aesthetic results.

A prospective, multicentre study of malignant and premalignant lesions at the base of periocular cutaneous horns.

PURPOSE: The primary objective of the study was to determine the incidence of the various pathological conditions present at the base of the periocular cutaneous horns. The secondary objective was to study the presentation of these cutaneous horns with a view to finding any clinical indicators for premalignant, malignant and benign lesions at the base. METHODS: Prospective multicentre study of patients presenting with cutaneous horns. Informed consent followed by excision biopsy of the base lesion was performed in all the cases included for the study. The biopsy specimens were examined histologically and results analysed. RESULTS: Twenty-six patients presented with cutaneous horns in the periocular region over a period of 2 years, of these two patients presented with more than one cutaneous horn. 23 patients underwent excision biopsy. There were a total of 25 specimens. Of the base lesions 2/25 (8%) were malignant, 7/25 (28%) were pre-malignant and the remaining 16/25 (64%) were benign. Analysis of the findings on clinical presentation revealed no clinical indicators to correlate with the final histology. CONCLUSION: The incidence of malignant and pre-malignant lesions present at the base of periocular cutaneous horns was 36% with 8% of them being malignant. It is important to perform an excision biopsy with histological diagnosis of the base of the cutaneous horn as there are no definite clinical features that point towards a potential for malignancy.

Finger-Prick Autologous Blood in the Treatment of Persistent Corneal Epithelial Defects.

PURPOSE: Autologous hemoderivative eye drops have a role in the management of persistent epithelial defects (PEDs), but their use may be limited by cost and availability. Finger-prick autologous blood (FAB) treatment uses whole capillary blood, obtained from a sterilized fingertip, as an alternative form of hemoderivative eye drop therapy. To date, 1 report has described the safe and effective use of FAB for dry eye and PEDs. We report the results of 10 eyes (10 patients) treated with FAB for PEDs. METHODS: Ten patients with PEDs in 1 eye for a mean of 259 ± 201 days due to diabetic neurotrophic keratopathy (n = 3), herpetic keratitis (n = 3), postpenetrating keratoplasty (n = 1), keratoconjunctivitis sicca (n = 1), postradiotherapy (n = 1), and neuropathic ulcer (n = 1) were treated with FAB 4 times a day for 28 days in addition to conventional therapies. All patients had been unsuccessfully treated with conventional therapy before commencing on FAB. None of the patients had received any surgical treatment for PED. RESULTS: At day 28, the PED had healed in 60% (n = 6) of the eyes. In 1 eye, the PED reduced in size by half. Thirty percent (n = 3) of patients had incomplete follow-up data at the end of the study. CONCLUSIONS: FAB in combination with conventional treatment may be successfully used in the management of refractory PEDs. No adverse effects arising from FAB treatment were observed.

Punch biopsy in the management of periocular basal cell carcinomas.

AIM: The aim of this study was to define the role of punch biopsy in the management of periocular basal cell carcinomas. PATIENTS AND METHODS: A case-note review was performed on 24 patients undergoing punch biopsies for eyelid lesions. Depending on the clinical diagnosis, two groups were identified: Group A with periocular basal cell carcinomas and Group B with periocular lesions other than basal cell carcinoma. The histopathological diagnosis based on punch biopsy specimens was compared with (a) the clinical diagnosis and (b) the final histopathological diagnosis based on the excision biopsy specimen. RESULTS: The punch biopsy confirmed the diagnosis of basal cell carcinoma in 14 of 16 cases in Group A and 2 of 8 cases in Group B. Clinical characteristics when used alone in the diagnosis of basal cell carcinoma had a positive predictive value of 87.5% and a negative predictive value of 75%; hence a sensitivity of 87.5% and a specificity of 75%. Appropriate surgical intervention (two-stage tumour excision and lid reconstruction) was performed in 2 of 8 cases (25%) not initially clinically diagnosed as basal cell carcinomas. Unnecessary surgical intervention was avoided in 2 of 16 cases (12.5%) clinically diagnosed as basal cell carcinomas. The final histopathological result in all cases undergoing surgical excision confirmed the diagnosis of basal cell carcinoma made from the punch biopsy tissue specimens. CONCLUSION: The results suggest that punch biopsy provides an accurate histopathological diagnosis prior to commencing definitive surgical management and may be a useful tool in the management of periocular basal cell carcinomas.