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.

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.

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 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.

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.

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.