Posterior Lamellar Augmentation With Auricular Cartilage Grafting for Severe Cicatricial Entropion Correction in Cicatricial Ocular Surface Disease.

Abstract

Purpose: Description of clinical profile, surgical technique, and outcomes in patients having severe entropion secondary to cicatricial ocular surface disorders, who underwent entropion repair and posterior lamellar augmentation using auricular cartilage graft.

Methods: A retrospective review of electronic medical records was performed over a 4-year period (August 2019-August 2023) to identify cases with entropion and cicatrizing ocular surface disorders that had undergone entropion repair with auricular cartilage grafting.

Results: Seventeen eyelids of 15 patients were included. The average age of the study population was 33.17 ± 16.8 years, with an almost equal male to female ratio (8 male, 7 females). Lower eyelid was more commonly involved (n = 11, 64.7%) than the upper eyelid (n = 6). Steven-Johnson syndrome (n = 11, 64.7%) was the most frequent etiology. Two patients (13.3%) underwent bilateral surgical repair, whereas in 5 eyelids (29.4%), the procedure was combined with lid margin mucous membrane grafting at the same sitting. Cartilage graft was harvested through posterior auricular approach in all cases. Postoperatively, entropion correction was achieved in 16 eyelids (94.1%), and postoperative improvement in ocular surface scoring was noted in 11 eyelids (64.7%). Improvement in visual acuity postoperatively was noted in 52.9% eyes. Over an average follow-up of 16.64 months, 1 eyelid (5.8%) required additional everting sutures and 1 eyelid (5.8%) needed trimming of the graft.

Conclusions: Cartilage graft-aided entropion surgery is a viable and satisfactory management option in severe cicatricial entropion in ocular surface disorders and can be combined with lid margin mucous membrane grafting for simultaneous correction of lid margin keratinization. Auricular cartilage is a versatile graft with easy harvesting and minimal donor-site morbidity.