and hypertrophic changes in their eyelids at their postoperative week 4 visit. If they required intralesional wound modulation, an intradermal injection of approximately 0.1-0.2ml of combined 5-FU (50mg/ml, Fresenius Kabi, Lake Zurich, IL) and triamcinolone (10mg/ml, Bristol-Myers Squibb Company, Princeton, NJ) mixed with 1% lidocaine (Hospira Inc, Lake Forest, IL) was injected to targeted areas along the upper eyelids. The pain of the injection can be substantially reduced by adding 1% lidocaine (1:1:1 of 5-FU: triamcinolone: 1% lidocaine) in the same syringe along with the use of topical anesthetics. Patients who received 5-FU and triamcinolone injections were informed of the off-label use, and each signed a separate informed consent for the injection. If they required an intralesional injection at their visits, they were seen one month later in lieu of their planned postoperative visits. When indicated, repeat intralesional injections were performed monthly.The indication for intralesional injection was determined by the scar characteristics using a modified Vancouver Scar Scale (Table 1), which has been previously published.26 The parameters assessed by the scale include: vascularity, height, pigmentation, and pliability. A 4-point scale was used to assess vascularity and height of scars. A 6-point scale was used to assess scar pigmentation and pliability. In each case, a higher score denoted a worse outcome. Inclusion criteria for intralesional injection included: Pliability grade that was “yielding” or worse (Grade 2 or higher) and a Height grade that was “moderate” or worse (Grade 2 or higher).
RESULTS
A total of 272 eyelids (136 patients) were identified that underwent upper eyelid blepharoplasty, mean age, 52.1 (+/- 12.7) years; 30 males and 106 females. Of these, 140 eyelids (70 patients) underwent upper eyelid blepharoplasty and were treated with SKN2017B twice a day for 3 months beginning 2 weeks post procedure; mean age, 51.7 (+/- 11.5) years; 17 males and 53 females. The remaining 132 eyelids (66 patients) did not receive any postsurgical topical scar treatment; mean age, 53.7 (+/- 14.4) years; 13 males and 53 females. The cohort was followed for an average of 6.4 (+/- 4.0) months. Those treated with SKN2017B post blepharoplasty were followed for an average of 6.2 (+/- 3.6) months. Those that received no topical scar treatment post blepharoplasty were followed for an average of 6.6 (+/- 4.5) months. Within the follow-up period, of those treated with SKN2017B post blepharoplasty, 22.9% received at least one round of intralesional injection postoperatively; 32 eyelids of 21 patients (17 right eyelids, 15 left eyelids). In contrast, of those that received no topical scar treatment, 43.9% received at least one round of intralesional injections postoperatively; 58 eyelids of 35 patients (27 right eyelids, 31 left eyelids). The difference in the number of eyelids that received combined intralesional injections of triamcinolone and 5-FU was found to be statistically significant between the two groups; P<0.05.Within the SKN2017B group, the number of injections each eyelid received per treatment ranged from 1 to 3, with an average of 1.31 injections per treatment. Within the group that received no treatment, the number of injections each eyelid received ranged from 1 to 3, with an average of 1.40 injections per treatment. The average number of injections per treatment for the cohort as a whole was 1.37. The difference between the number of injections administered per treatment between the two groups was not found to be statistically significant. Within the SKN2017B group, 6.4% of those eyelids that received intralesional injections received more than 1 treatment session; 2 eyelids of 2 patients (2 left eyelids). Within the no treatment group, 27.6% of eyelids that received intralesionalinjections received more than 1 treatment session; 16 eyelids of 11 patients (8 right eyelids, 8 left eyelids); Figure 1. Therewas a statistically significant reduction in the need for repeat injections in the group that received SKN2017B [2 eyelids(6.4%)] when compared to those that received no treatment [16 eyelids (27.6%)]; Pbetween the groups or cohort as a whole in the injection frequency between the left and right eyelids.
