Multiple Layered Free grafts for the Management

of Cryptophthalmos

Dr Ramesh MurthyDr Himika Gupta

May 1, 2023

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Introduction • Cryptophthalmos Greek, Kryptos (hidden) +

ophthalmos(eye) • Eyeball covered by skin

• To describe the application of multiple layered grafts for the management of cryptophthalmos

in single surgery

Types

Partial Complete

Purpose

May 1, 2023

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Patient 1: 2 month old baby boy•Incomplete upper lid •Partially hidden eyes•Corneal opacity•Symblepharon superiorly

Partial cryptophthalmos

Materials and methods

May 1, 2023

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Patient 1• Corneal ulceration within 5 days

• Imminent closure of eyes needed

• Create the eyelid OUR PLAN ▫Anterior lamella – skin graft ( maternal)▫Tarsal plate – donor sclera▫Conjunctiva – mucus membrane ( maternal)▫Amniotic membrane- cover the epithelial surface

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Surgery

Release of symblepharon

Estimating skin graft size

Maternal retroauricular graft

Skin graft sutured to upper lid

May 1, 2023

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Sclera sutured in place – for tarsus

Mucus membrane graft sutured for conjunctiva

Donor Sclera

Amniotic membrane for the surface

Conformer placed; temporary tarsorrhaphy done

Surgery

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One year post surgery•Reconstructed upper lids

•Proper lid closure with no lagophthalmos

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Patient 2: 25 year old adult male

•Right : superomedial lid coloboma

•Left :▫No eyeball seen left

side▫Lack of eyebrows

medially bilaterally▫Rudimentary eyeball

seen on ultrasound▫Total ankyloblepharon Complete

cryptophthalmos

May 1, 2023

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Surgery

Sclera sutured in place – for tarsus

Oral mucus membrane sutured for – for conjunctiva

Retroauricular donor skin

Skin graft sutured in upper lid

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One year post surgery•With conformer in place

•With custom made artificial eye

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Discussion • Placement of grafts

▫every layer in direct contact with some amount of recipient tissue

▫which provided the blood supply and nourishment for the graft to survive.

• Levator palpebrae superioris remnants identified and skin sutured to it▫Rendered motility to the lids▫Enabled proper blinking ▫Good functional results

• Maternal tissue provided good match in the child

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Conclusion •Multilayered free grafts in

cryptophthalmos

•Performed in single surgical sitting, avoiding multiple surgeries and with minimal morbidity

Achieve good

rehabilitation

Anatomical Functional Cosmetic