Ophthalmic plastic applications of acellular dermal allografts

Purpose: Clinical problems of contracted conjunctival fornices, superior su lcus defects, and soft tissue contour defects in the periorbital region hav e not shown good, sustained results with a range of autologous and alloplas tic implants. AlloDerm (Lifecell Corp., Woodlands, TX) is an acellular derm al graft processed from human donor tissue. The authors sought to assess th e efficacy of AlloDerm as a soft tissue replacement in a variety of oculopl astic applications. Design: Retrospective, noncomparative case series, Participants: Twenty-three patients. Methods: Applications were broadly classified as barrier/scaffolding (i.e., primary and secondary implant coverage, lid spacer graft) and volume augme ntation (i.e., superior sulcus and other periorbital soft tissue contour de fects). Barrier grafts were applied as single sheets. Stacked sheets or rol led grafts were used for augmentation. Collectively, this material was used in 29 cases with 3 to 16 months' follow-up. Main Outcome Measures: Clinical evaluation of outcome and complications. Results: As a soft tissue scaffolding and barrier implant, AlloDerm persist ed sufficiently to permit repopulation with native tissue. Rolled/stacked i mplants demonstrated unpredictable resorption. Upper eyelid grafts seemed t o have higher resorption rates than lower eyelid grafts. One case of anopht halmic superior sulcus augmentation required two revision surgeries to prov ide sufficient volume augmentation. The grafts were well tolerated, with no cases of infection or explanation. Conclusion: Acellular human dermis is an excellent barrier and reconstructi ve grafting material that provides an alternative to autologous grafts and other alloplastic material, avoids harvesting autologous tissue, possesses excellent handling properties, and is associated with minimal inflammation. Long-term follow-up is required to evaluate persistence.