title: Correction of lower lid retraction using tarSys bioengineered grafts for graves ophthalmopathy.
abstract: OBJECTIVE
  To investigate the efficacy of decellularized porcine-derived membrane (tarSys; IOP Inc), a bioengineered eyelid spacer graft, for lower lid retraction correction in patients with Graves ophthalmopathy.
  
  
  METHODS
  Retrospective observational case series study.
  
  
  METHODS
  This was a retrospective review of patients with Graves ophthalmopathy undergoing lower eyelid retraction surgery using decellularized porcine-derived membrane bioengineered eyelid spacer grafts from 2008 through 2011. Outcome measures included lower eyelid height (measured from the corneal light reflex to the lower eyelid margin, or marginal reflex distance-2 [MRD2]), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed for functional and cosmetic outcome.
  
  
  RESULTS
  A total of 32 Graves patients and 37 eyelids underwent lower eyelid retraction surgery using decellularized porcine-derived membrane. There were 10 male and 22 female patients with mean age of 41.8 ± 8.6 years. Mean improvement in MRD2 was 1.4 ± 0.4 mm. Mean reduction of lagophthalmos was 1.3 ± 0.4 mm. There are statistically significant differences between preoperative and postoperative MRD2 and lagophthalmos (paired t test, both P < .0001). No evidence of infection and corneal erosion was noted and none of the patients needed further surgeries. Prolonged lower lid swelling and slight puffy appearance were noted for 6 patients. The swelling and puffy appearance resolved completely 3 months after surgery. Conjunctival granuloma formation was found in 1 patient. The cosmetic result was satisfactory in all cases.
  
  
  CONCLUSIONS
  Decellularized porcine-derived membrane, a bioengineered graft, is effective for the management of lower lid retraction in patients with Graves ophthalmopathy. It can offer an alternate graft for eyelid reconstruction.
authors: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taipei, Taiwan. liaosl89@ntu.edu.tw
authors: Shu Lang
authors: SL
authors: Liao
authors: Yi Hsuan
authors: YH
authors: Wei
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000818:Animals; D057005:Bioengineering; D019299:Decompression, Surgical; D004954:Esthetics; D005141:Eyelid Diseases / Q000503:physiopathology / Q000601:surgery*; D005143:Eyelids / Q000033:anatomy & histology / Q000502:physiology; D005260:Female; D006111:Graves Disease / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016038:Skin Transplantation; D013536:Suture Techniques; D013552:Swine; D014183:Transplantation, Heterologous; D016896:Treatment Outcome