Treatment of degenerative entropion with lower eyelid muscle reduction and lateral tarsal plate fixation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the effects and complications of retractor repair combined with a lateral tarsal strip procedure and retractor repair alone for treating lower eyelid involutional entropion.<p>METHODS: This was a prospective study. Totally 79 cases(91 eyes)with involutional lower eyelid entropion who were hospitalized from January 2015 to February 2018 were divided randomly into observation group(41 cases 46 eyes, underwent combined procedure)and control group(38 cases 45 eyes, underwent retractor repair procedure). The clinical effects and the complications of the two groups were compared.<p>RESULTS: At 3mo postoperatively, there was no significant difference in the clinical effective rate(100% <i>vs</i> 98%, <i>P</i>=0.495)between the two groups. At 24mo postoperatively, the observation group had a higher clinical effective rate(98% <i>vs </i>84%, <i>P</i>=0.030). There were no complications occurred in the observation group, significantly fewer than the control group(11%,<i> P</i>=0.026).<p>CONCLUSION: Compare to retractor repair procedure, the combined procedure has a higher clinical effective rate and a lower complications rate.

The Lateral Tarsal Strip for Paralytic Ectropion in Patients with Leprosy

BACKGROUND: In patients with leprosy, paralysis of the facial nerve results in the lower eyelid ectropion and lagophthalmos as a sequela even when the leprosy is cured. Paralytic ectropion causes many functional and cosmetic eye problems, leading to blindness if left untreated. OBJECTIVE: The purpose of this retrospective study is to evaluate the efficacy of surgical correction of paralytic ectropion, the lateral tarsal strip, in patients with leprosy. METHODS: Between 2010 and 2015, 40 Korean patients (44 eyelids) with paralytic ectropion who had visited Korean Hansen Welfare Association Hospital were treated with the lateral tarsal strip. Four-point patients' global assessment scale, local complications, and recurrence were assessed at the end of follow-up period. The average follow-up period was 12 months. RESULTS: In the 44 eyelids, recurrence was observed in 5 cases (5/44, 11.4%). There were no serious postoperative complications except mild size discrepancy of both eyes. Most patients were satisfied with the results and mean satisfaction scale was 2.6/3. CONCLUSION: The lateral tarsal strip is a simple, safe, and effective treatment method for the dermatologic surgeon to correct paralytic ectropion of mild to moderate degree in patients with leprosy.

Clinical Effectiveness of the Lateral Tarsal Strip Procedure

PURPOSE: To evaluate the clinical indications and efficacy of the lateral tarsal strip procedure. METHODS: The medical records of patients who underwent the lateral tarsal strip procedure between September 2008 and February 2014 were retrospectively reviewed. We examined age, gender, diagnosis, procedures simultaneously performed with the lateral tarsal strip, duration of observation, postoperative complications and cases requiring revision surgery. Patients without recurrence or undercorrection of eyelid/lateral canthal area lesions, surgical complication and not requiring revision surgery until final visit were considered as successful cases. RESULTS: One hundred eighty-three eyes of 129 patients were included in this study. The mean patient age was 61.6 years and average follow-up duration was 9.2 months. Diagnoses of eyes were lower lid laxity (39.9%), involutional entropion (24.0%), lower lid retraction (14.8%), cicatricial ectropion (6.6%), lateral canthal deformity (5.5%), involutional ectropion (3.8%) and paralytic ectropion (2.7%). Surgical procedures simultaneously conducted with lateral tarsal strip in 167 eyes of 183 eyes were endoscopic dacryocystorhinostomy (30.5%), lower retractor tightening (19.2%), medial spindle procedure (13.8%), mid-lamellar lengthening (12.6%), lower blepharoplasty (10.8%), Quickert suture (4.2%) and Hotz's operation (3.0%). Successful results were obtained in 116 of 129 patients (89.9%). CONCLUSIONS: The lateral tarsal strip procedure can successfully correct lower lid laxity and be used in various clinical indications with or without other surgical procedures.

Application of Lateral Tarsal Strip Procedure in Operation of Lower Eyelid Lesions / 昆明医科大学学报

Objective To evaluate the application of the lateral tarsal strip procedure for lower eyelid lesions. Methods We retrospectively analyzed 64 eyelids of 48 patients with lower eyelid laxity, ectropion, retraction, lagophthalmus and lateral canthus displacement from February 2010 to August 2013. All the patients were treated with the lateral tarsal strip procedure as the main surgical style, of which some combined with the surgery of lower-eyelid tarsal constrictor,some implanted with high porous polyethylene lower eyelid spacers (Medpor LES), and few cases of eyelid ectropion underwent transplantation or transposition of flap. The effect of relocation of lower eyelid and appearance improvement were evaluated after surgery. The degree of the low eyelid retraction, lagophthalmus and the lateral canthus displacement were examined quantitatively before and after operation, while the change of the low eyelid ectropion and laxity were done qualitatively. Results After two weeks of operation, eyelids of all the patients were relocated well except two cases of ectropion under mild correction. The quantitative evaluation showed there was significant difference between pre and post operation ( <0.001),while the qualitative effect of correction was satisfied after operation. Conclusion The lateral tarsal strip procedure had positive effects in the treatment of most sorts of lower eyelid diseases.

Combined operation for the relaxation of degenerative entropion / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To analyze and explore the clinical efficacy of strengthening lateral tarsal strip and advancing lower eyelid retractor for the treatment of degenerative entropion with eyelid relaxation METHODS: Reviewed from January 2011 to January 2013, 21 cases (33 eyes) of degenerative entropion eyelid relaxation were treated with operation of strengthening lateral tarsal strip and advancing lower eyelid retractor ( fornix conjunctival incision ) , the follow-up was 12-24mo, curative effect was observed. RESULTS: All the patients were cured completely, have no recurrence or overcorrection phenomenon. The cure rate of operation was 100%, there was no complication. CONCLUSlON: Operation of strengthening lateral tarsal strip and advancing lower eyelid retractor is a safe, reliable, efficient operation to the treatment of degenerative entropion with mode of eyelid relaxation.

Involutional Ectropion Repair with the Modified Medial Spindle and the Lateral Tarsal Strip Procedure

PURPOSE: To evaluate the effects of the modified medial spindle and the lateral tarsal strip procedure in involutional ectropion patients. METHODS: The lateral tarsal strip procedure with the modified medial spindle procedure that adjusts the size and the position of the spindle along the severity of lower eyelid eversion was performed on 17 eyes of 12 patients with involutional ectropion. The average follow-up period was 19.6 months. RESULTS: All 12 patients were male, and the mean age was 65.4 years (range 54 to 78 years). There was no recurrence in any of the 17 eyelids. However, a mild lower lid retraction and a mild punctal eversion not requiring reoperation occurred in the follow-up period. CONCLUSIONS: The lateral tarsal strip procedure combined with the modified medial spindle appears to be effective in the surgical treatment of involutional ectropion.

Lateral Tarsal Strip Procedure Combined with Quickert Sutures in Correcting Involutional Entropion

PURPOSE: To evaluate long-term effectiveness of lateral tarsal strip procedure combined with Quickert sutures in correcting involutional entropion. METHODS: The retrospective study reviewed 82 eyes of 71 patients with involutional entropion whose follow-up period was more than 6 months among patients who underwent lateral tarsal strip procedure combined with Quickert sutures between February 2003 and February 2010. RESULTS: The postoperative follow-up period was 6 months to 78 months (average 40.2 months) and the average age was 63.5 years. Out of 82 eyes, 3 eyes recurred and the recurrence rate in the lateral tarsal strip procedure combined with Quickert sutures was 3.6%; postoperative overcorrection was not observed. Out of the 3 recurrence cases, 2 eyes both recurred 6 months after the operation and were treated by Quickert sutures alone with no recurrence. The other case recurred 1 year and 4 months after lateral tarsal strip procedure combined with Quickert sutures and was corrected by this operation again. There was no recurrence for a follow-up period of 2 years. CONCLUSIONS: An effective approach was obtained during long-term follow-up when lateral tarsal strip procedure combined with Quickert sutures was conducted as repairing operations in involutional entropion. The approach showed lower recurrence rate than the existing reports of operations such as lateral tarsal strip procedure or Quickert sutures when conducted alone and provided long-lasting effectiveness in the correction of involutional entropion.

Lateral tarsal strip operation for the correction of paralytic and involutional Ectropion in Sorokdo Leprosy Patients / 나학회지

PURPOSE: To evaluate the effect of the lateral tarsal strip for the correction of the paralytic and involutional ectropion in Sorokdo leprosy patients. METHODS: Lateral tarsal strip operations were performed in 23 Sorokdo leprosy patients with recurrent corneal erosion and exposure keratopathy due to ectropion. Preoperative and postoperative sclera show and lagophthalmos were measured with a slit lamp, and anterior segment findings were taken at 1 week, 2 weeks and last follow up after the surgery. Postoperative subjective functional improvements were assessed at the last follow up. RESULTS: There was significant reductions between preoperative and postoperative measurements for scleral show (from 2.19 +/- 0.22 mm to 0.37 +/- 0.11 mm) and lagophthalmos (from 4.51 +/- 0.38 mm to 2.07 +/- 0.24 mm) (p<0.05). Ocular irritation symptoms including pain and tearing, and cosmetic satisfaction significantly improved after the surgery. CONCLUSIONS: Lateral tarsal strip operation is an effective surgical option in the treatment of paralytic and involutional ectropion in leprosy patients.

Lateral Tarsal Strip Procedure and Silicone Tube Intubation on the Functional Nasolacrimal Duct Obstruction

PURPOSE: To compare the effects of the lateral tarsal strip procedure alone and the lateral tarsal strip procedure combined with silicone tube intubation in the treatment of functional lacrimal duct obstruction. METHODS: The present study investigated 27 eyes of 20 patients underwent lateral tarsal strip procedure (LTS) alone and 29 eyes of 18 patients underwent combined lateral tarsal strip procedure and silicone tube intubation and who were diagnosed with functional lacrimal duct obstruction. The authors retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, tear meniscus height (TMH), and symptoms. RESULTS: The average age of the LTS alone group was 60.3 years, and that of the combined groups was 65.9 years. The TMHs in the LTS only and combined operation groups were 0.62 +/- 0.23 mm and 0.62 +/- 0.19 mm before the operation and 0.43 +/- 0.20 mm and 0.26 +/- 0.09 mm after the operation, respectively. The postoperative improvement in epiphora was 74.1% after the LTS alone and 86.2% after combined LTS with silicone tube intubation. The postoperative improvement in epiphora and the operative technique of the lateral tarsal strip-canthus sparing or cantholysis were not relevant. CONCLUSIONS: Lateral tarsal strip combined with silicone tube intubation appeared useful in the treatment of epiphora patients without anatomic lacrimal duct obstruction. Determining which operative technique of lateral tarsal strip procedure should be chosen is difficult, and the preoperative syringing and snap back test may be helpful.

The Effect of Augmented Lateral Tarsal Strip for Paralytic Ectropion in Leprosy Patients

PURPOSE: To analyze the effect of the augmented lateral tarsal strip for the correction of the paralytic ectropion in leprosy patients. METHODS: Ten leprosy patients (16 eyelids) with exposed keratitis and lagophthalmos from paralytic ectropion underwent surgery of the augmented lateral tarsal strip. Preoperative and postoperative vertical palpebral aperture, marginal reflex distance, lagophthalmos, and anterior segment findings were recorded at 3 and 6 months after surgery. Postoperative symptomatic and functional improvements were assessed at 6 months after surgery. RESULTS: There was a significant reduction between preoperative and postoperative measurements for vertical palpebral aperture (3.1+/-0.4 mm), lower marginal reflex distance (2.1+/-1.0 mm), and lagophthalmos (2.0+/-1.2 mm). Eye irritation symptoms and lid functions were improved in all patients. In a survey, the symptomatic, functional satisfaction was achieved in 90% of patients. CONCLUSIONS: The augmented lateral tarsal strip is a sufficiently effective surgical procedure to be considered in the treatment of paralytic ectropion in leprosy patients.

Reappraisal of the lateral tarsal strip in the treatment of paralytic ectropion / 나학회지

The imbalance between paralyzed orbicularis oculi and normally functioning its antagonists such as the levator of the upper lid and the capsulopalpebral fascia of the lower lid in patients with leprosy causes ectropion, eyelid retraction and lagophthalmos. There are a lot of surgical methods to manage the ectropion and retraction of the lower lid including lateral canthoplasty, lateral canthopexy, spacer graft, canthal sling, medial tarsorraphy as well as temporal fascia transfer. In this study, we applied the lateral tarsal strip combined with Kuhnt- Szymanowski procedure to thirty-two patients with paralytic ectropion and this method was proven to be very effective in correcting the abnormal conditions.

Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion

PURPOSE: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion. METHODS: This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb). RESULTS: The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively. CONCLUSIONS: The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.

The Effects of Lateral Tarsal Strip Procedure on the Functional Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the effects of the lateral tarsal strip procedure in the treatment of lacrimal pump dysfunction related to lower lid laxity. METHODS: This study investigated 46 eyes of 35 patients diagnosed with dysfunction of the lacrimal pump on which the lateral tarsal strip procedure was performed between June 2001 and February 2004. We retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, change of fluorescein dye disappearance test (DDT), tear meniscus height (TMH), symptoms, and complications. RESULTS: Improvement of tearing was noted in 26 patients (78.8%). Thirty-seven eyes (80.5%) were improved by more than 1 grade on DDT. Significant improvement above 2 grades was observed in 16 eyes (34.7%). With respect to age, 62.5% of 3rd-decade patients improved most effectively by more than 2 grades on DDT. Postoperative TMH compared with preoperative TMH measures were significantly lower according to statistics. The most common complication was discomfort or tenderness over the orbital rim (13.0%). CONCLUSIONS: Performance of the lateral tarsal strip procedure for tearing caused by dysfunction of the lacrimal pump and related to lower lid laxity improved patients' tearing, DDT and TMH status. We therefore expect the lateral tarsal strip procedure to be effective in the surgical treatment of lacrimal pump dysfunction secondary to lower eyelid laxity.

Correction of Lower Lid Retraction Combined with Entropion using an Ear Cartilage Graft in the Anophthalmic Socket

PURPOSE: To investigate the surgical results of an ear cartilage graft and supplemental procedures for correcting lower lid retraction combined with entropion in anophthalmic patients. METHODS: We reviewed retrospectively the medical records of 7 anophthalmic patients with lower lid retraction and entropion, who received a posterior lamellar ear cartilage graft and one or both of lateral tarsal strip or eyelash-everting procedure between March 1998 and March 2003. Preoperative and postoperative lid and socket statuses were also investigated. RESULTS: Ear cartilage grafts were performed in all 7 patients, lateral tarsal strips in 6, and eyelash-everting procedures in 5. Postoperative follow-up durations ranged from 4 to 28 months (average 12.6 months). Retractions were corrected during follow-up in all patients. There were no cases of entropion immediately after surgery. However, the eyelashes of the lower lid returned to an upright position in 4 patients, but not so severe as to touch the ocular prosthesis, and thus did not require surgical correction during follow up. CONCLUSIONS: Lower lid retraction combined with entropion in anophthalmic patients can be corrected effectively using an ear cartilage graft with selective, supplemental procedures.

A CASE REPORT ON THE SURGICAL TREATMENT FOR THE ECTROPION AS A COMPLICATION OF RECONSTRUCTION OF BLOW-OUT FRACTURE

Ectropion is a drooping or eversion of the lower eyelid as a result of lower lid laxity, canthal tendon laxity, or cicatrix formation from scarring. Ectropion can also be congenital or develop with aging. This complication can arise from primary trauma to the lower lid apparatus or as a result of unfavorable healing and scar contracture. To prevent development of ectropion, a careful attention in case of operation for orbital frature repair or blepharoplasty is necessary. Especially, excessive dissection or retraction of skin and orbicularis muscle should be avoided, and formation of edema and hematoma should be prevented by complete hemostasis. It might be helpful to massage on the eyelid frequently. In spite of endeavors mentioned above, lareral canthoplasty or skin graft must be performed when postoperative ectropion is occurred. With literature review the authors present a case report that good clinical result is achieved by lateral tarsal strip procedure on cicatricial ectropion caused by a complication of reconstruction of blow-out fracture.

Surgical Correction of Senile Entropion

Senile entropion is caused by following pathophysiology: 1) Dehiscence or disinsertion of lower lid retractors from lower tarsus, 2) Preseptal orbicularis overriding pretarsal orbicularis, 3) Horizontal lid laxity from involutional changes of medial canthal ligament, lateral canthal ligament and tarsal plate, 4) Relative enophthalmos from absorption of orbital fat. There have been numerous procedures to correct senile entropion, but lack of adequate correction of all of the underlying anatomic defects resulted in high recurrence rate. Authors performed a combined procedure including the reinsertion of disinserted or dehisced lower lid retractor to lower tarsus, the excision of overriding preseptal orbicularis, and the correction of the lower lid laxity using lateral tarsal strip procedure all at once Among 11 cases of 10 patients, 10 cases had cosmetically and functionally good lid position during the mean follow up periods of 13.4 months. There was one case of ectropion as a complication which was corrected by further lateral tarsal strip procedure.