A new method using xenogeneicacellular dermal matrix in the reconstruction of lacrimal drainage

Abstract

AimsTo prospectively evaluate the reliability and efficacy of a new treatment for the reconstruction of the lacrimal duct using a new histo-engineered material, xenogeneic (bovine) acellular dermal matrix.MethodFive patients (five eyes) with partial or total absence of the lacrimal duct were included in the study. Four patients (four eyes) suffered from traumatic injuries to the lacrimal duct and one patient (one eye) had congenital absence of the lacrimal drainage system. A pedal graft of conjunctiva was taken from the fornix area and rolled into a tube structure after being attached to the acellular dermal matrix.ResultsThe average duration of follow-up for the patients was 7.2 months (ranging from 6 to 12 months). After surgery, the new duct in the nasal cavity could be observed above the middle turbinate by nasal endoscopy. Patency was confirmed by pressing in the area of the lacrimal sac and visualising air bubbles in the nasal cavity. Additionally, the meatus above the middle turbinate of the nasal cavity was stained and visualised after patients underwent Jones dye test 1 (JDT1). Five tear ducts proved to be effective through irrigation testing and epiphora symptoms were alleviated in all cases.ConclusionsThe newly reconstructed lacrimal duct, formed by the shift of autogenous conjunctival petal and the attachment of acellular dermal matrix, was successful in all five cases and suggests a new solution for the complex lacrimal duct lesion and congenital anomalies of the lacrimal duct.

Management of Traumatic Lower-Eyelid Avulsion and Complete Loss of the Lacrimal Canaliculus: A Case Report

“…Many published papers describe surgical techniques for traumatic canalicular reconstruction when tissue is preserved [14, 15, 16, 17, 18, 19, 20, 21, 22]. However, there are only few reports about the reconstruction of a lost non-preserved canaliculus [5, 23]. If just part of the canaliculus is lost due to an injury, resected during removal of an eyelid tumor or during repair of severe medial ectropion with marked laxity of the medial canthal tendon, the remaining section of the canaliculus can be exteriorized to the lacrimal lake [11, 24].…”

“…On the other hand, when the entire canaliculus is lost, the reconstruction with buccal mucosa enveloping a silicone stent positioned between the anterior and posterior lamella has been recognized as a possible surgical option [5]. Chen et al [23] described the method for the reconstruction of a lost lacrimal ductus by using xenogeneic bovine acellular dermal matrix for the outer support structure and a free conjunctival graft for the inner wall of a newly formed ductus. Such a method could also be used for the surgical management of missing lacrimal canaliculi.…”

“…Such a method could also be used for the surgical management of missing lacrimal canaliculi. The results of such a challenging reconstruction are often unsuccessful and disappointing [5, 23]. Subsequent epiphora can be prevented by performing a conjunctivodacryocystorhinostomy (CDCR) with Jones tubes where a connection between the medial fornix and the nasal cavity is made.…”

“…The surgical management is potentially applicable also for reconstructions after removal of tumors in this region, or when dealing with canalicular stenosis of iatrogenic or congenital etiology. Due to a relatively uncomplicated canalicular reconstruction, which does not require grafting of additional tissues as described in previous papers [5, 23], we recommend trying to reconstruct the canaliculus in selected cases using the described method. If this method fails, later use of more demanding surgical methods [5, 23] or performing CDCR using a Jones tube in symptomatic patients is still possible.…”

Lacrimal gland development: From signaling interactions to regenerative medicine

“…There are still challenges regarding optimization of the decellularization technique, the seeding process, the long-term culturing conditions, and functional validation. It is notable, however, that a lacrimal outflow duct constructed using acellular bovine dermal matrix has been successfully transplanted into patients to relieve obstructive signs and symptoms (Chen et al, 2014a). Through providing effective mechanical strength, the appropriate micro-environment for lacrimal gland cells, and the necessary structural support for vascular, nerve and ductal supply, the decellularized matrix promises to be an ideal scaffold for bioengineered lacrimal gland.…”