Use of the tarSys® for posterior lamellar grafting for lower
John H. Leonard
Adam J. Cohen
Received: 17 May 2013 /Accepted: 25 July 2013 /Published online: 21 August 2013
Springer-Verlag Berlin Heidelberg 2013
Background Lower eyelid malposition is a common clinical
finding encountered by the oculoplastic surgeon. We examine
the short-term results with the use of the tarSys spacer graft for
the correction of lower eyelid malposition.
Methods A retrospective chart review of one surgeon’sout-
comes with use of tarSys spacer graft for lower eyelid malpo-
sition was conducted.
Results Preoperative margin-to-reflex distance 2 (MRD2)
ranged from 8 to 15 mm with a mean of 9.5 mm
(±2.4 mm) and median 8.25 mm. Mean postoperative
MRD2 was 6.2 (±3.4 mm) ranging from 4 to 17 mm with
a median of 5.0 mm. Improvement in MRD2 averaged
3.33 (±2.07 mm), range −2to6mm,andamedianof
3.25 mm. Preoperative lagophthalmos ranged from 0 to
10 mm with mean 3.9 (±3.6 mm) and a median of 3.0 mm.
Mean postoperative lagophthalmos was 1.3 (±1.5 mm)
ranging from 0 to 4 mm with a median of 0.7 mm.
Improvement in lagophthalmos averaged 2.5 (±2.7 mm).
Conclusions The tarSys spacer graft should be thought of as a
dependable allogenic implant for posterior lamellar support
when correcting lower eyelid malposition.
Level of Evidence: Level V, therapeutic study.
Posterior lamellar spacer
Often referred to as the skeleton of the eyelid, the tarsus is
a hybrid collagenous tissue which provides structural sup-
port for the eyelids [1, 2]. The tarsus consists of mainly
types I, II, and VI collagen arranged in a dense fibrous
tissue rather than true cartilage. The unique structure of
this tissue makes the selection of an appropriate graft
material difficult. Contemporary grafts are often limited
by tissue failure, difficult shape constraints, and the need
to harvest tissue from other sites. Historically, both autog-
enous tissues and allogenic materials have been used for
this purpose. These include upper tarsus grafts, oral and
labial structures, conchal cartilage, nasal septum, and der-
mal fat grafts among others [3, 4]. These autogenous
grafts are limited by their donor site morbidity, varying
clinical success rates, and increased costs stemming from
longer operative times and the need for extra surgical
supplies [5, 6].
Allogenic materials such as acellular dermis and porcine
dermal collagen have been used more recently with varying
clinical results. The main difficulties encountered with these
materials are graft resorption and loss of rigidity secondary
to graft encapsulation on a microscopic level.
Encapsulation creates a cellular framework on the surface
of the graft that hinders fibroblast and capillary penetrance
into the graft [8, 9].
A novel allogenic material, porcine small intestinal submu-
cosa (SIS) (Cook Biotech, Inc., West Lafayette, IN, USA) has
garnered much attention for its use as a biodegradable scaffold
in numerous clinical scenarios . The tarSys® graft
(Innovative Ophthalmic Products, Inc., Costa Mesa, CA,
USA), processed with SIS technology, is a complex organi-
zation of collagen that has both fibrous and porous character-
istics. It is obtained by completely denuding the small intes-
tine submucosal tissue of cellular material, leaving behind a
dense connective tissue matrix consisting mostly of type I
J. H. Leonard
Rush University School of Medicine, Chicago, IL, USA
A. J. Cohen
Private Practice Eyelid and Facial Plastic Surgery, Glenview, IL,
A. J. Cohen (*)
Oculoplastic and Reconstructive Surgery, Division of
Ophthalmology, Rush University Medical Center, Chicago, IL, USA
Eur J Plast Surg (2013) 36:733–738