The search for an ideal graft material in the reconstruction of posterior lamellar defect of lower eyelid: an experimental study

Aim and hypothesis: The aim of our study was to compare the macroscopic and histopathological properties of graft materials that are used for the reconstruction of posterior lamellar defects of lower eyelid. All materials that have been used formed a bed for the overgrowth of adjacent conjunctiva. It is important to end this process on a fast, harmless and comfortable basis. There exist limited data on the comparison of graft materials that were used in the current study. Because of this, we used five different materials and compared their macroscopic and histopathologic properties in order to find out an ideal graft material.Method: In our study, 40 New Zealand rabbits are equally and randomly divided into 5 groups. Posterior lamellar defects 1 cm in length were surgically created in the lower eyelid of each rabbit. At the same time, autolog conjunctiva, septal mucosa, hard palate, HAM, and temporal fascial grafts were applied and sutured for each group. Glob and eyelids were observed. Chemosis, morphological distortion, and corneal ulcerations were recorded. In the end of 4 week follow up period, the grafts were totally extirpated for histopathological evaluation. Vascularity, fibrosis, inflammation, goblet cells, and conjunctival epithelization were investigated as histopathological parameters.Findings: There were no macroscopic complications in the conjunctival autografts. There was corneal ulser in one lower eyelid. The chemosis rate and morphological distortion was different between groups (p=0,037 and p<0,001 respectively). Corneal ulceration was not different between groups (p=0,0392). Likewise, there was no difference in inflammation, fibrosis, and vascularity of histopathological materials (p=0,910; p=0,187; and p=0,731 respectively). There was conjunctival epithelisation in all 40 lower eyelids. Goblet cells were observed in 100% of autolog conjunctiva grafts, 62% of temporal fascia, hard palate, and septal mucosa grafts, and 50% of HAM grafts (p=0,263). Temporal fascia and hard palate grafts were equally had the highest scores in overall histopathological system, and regarded as the ideal graft material in the current study.Result: We compared five different materials in five groups in order to find out an ideal graft material. Temporal fascia and hard palate grafts were demostraded as the ideal graft material in our study. Every materal that was used achieved to for a basis for adjacent conjunctival overgrowth. It is important to speed up the healing process and avoid complications. Although there is some data about various graft materials in the literature, results of comparative studies are lacking. We hope that our study will contribute to the application of temporal fascia grafts more frequently in clinical setting.