Long-term Results of Interrupted Buried Suture Method Using Non-absorbable Material for Involutional Lower Lid Entropion

PURPOSE: To introduce and evaluate the long-term effectiveness of interrupted buried suture using non-absorbable material in involutional lower lid entropion. METHODS: A total of 105 adult involutional lower lid entropion patients (135 eyes) from January 2010 to January 2015 with or without the horizontal laxity, and without a history of previous surgical treatment were included. Exclusion criteria included patients with cicatricial entropion, epiblepharon, history of previous lower lid surgery, and follow-up period less than 3 months. The central and lateral areas below the lower lid margin and below the inferior tarsal margin were connected by non-absorbable interrupted buried suture. Results were analyzed by objective outcome using measurements from clinical photographs, subjective outcome using improvements of patients' symptom and cosmetic satisfactions. RESULTS: This study included 135 eyelids. Pre-operative distraction test revealed horizontal laxity in 37 eyes (27.4%). The mean age was 79.50 years and the mean period of follow-up was 34.51 ± 3.8 months. In 133 eyelids (98.5%), post-operative lid positions have everted. Score of symptom improvements were 9.44 (0 to 10 scale). 99 patients (94.3%) were cosmetically satisfied. No surgical complications were observed. Although we had two recurred cases (1.5%), one with horizontal laxity (2.7%) and one without horizontal laxity (1.0%), reoperation was not performed due to mild subjective discomfort. CONCLUSIONS: For patients with involutional entropion regardless of horizontal laxity, a simple interrupted buried suture method using non-absorbable suture material showed excellent long term results in very low recurrence rate and high cosmetic satisfaction.

Quickert Suture Using Nonabsorbable Suture Material for Lower Lid Entropion

PURPOSE: To introduce the modified Quickert suture for lower lid entropion, using nonabsorbable suture material. METHODS: From October, 2011 to June, 2012, a total of 11 patients (12 eyes) with lower lid entropion, in poor general condition or who did not want extensive surgery, were recruited for the present surgery. Three small skin incisions were made at the medial, central, and lateral areas, just below the lower cilia. With double armed 6-0 nylon, each needle was inserted in the inferior conjuctival fornix and the 2 ends of the suture were tied and buried at the point of the skin incision site. Sutures were made at the medial, central and lateral areas. RESULTS: The patients consisted of 4 males and 7 females with an average age of 71.3 +/- 8.4 years (54-82 years). The patients were followed up the patients for an average of 13.9 +/- 2.4 months postoperatively. All patients were satisfied with the outcome, and there were no recurrences. CONCLUSIONS: Quickert suture is a simple and effective method, for correcting lower lid entropion by inducing scar formation with absorbable suture materials, but the effect duration is limited. Because the modified Quickert suture utilizes its own tension with a nonabsorbable suture material, the effect lasts as long as the suture material remains. It is a useful and practicable method for patients, in poor general condition or not wanting extensive surgical procedures.

Quickert Suture Using Nonabsorbable Suture Material for Lower Lid Entropion

PURPOSE: To introduce the modified Quickert suture for lower lid entropion, using nonabsorbable suture material. METHODS: From October, 2011 to June, 2012, a total of 11 patients (12 eyes) with lower lid entropion, in poor general condition or who did not want extensive surgery, were recruited for the present surgery. Three small skin incisions were made at the medial, central, and lateral areas, just below the lower cilia. With double armed 6-0 nylon, each needle was inserted in the inferior conjuctival fornix and the 2 ends of the suture were tied and buried at the point of the skin incision site. Sutures were made at the medial, central and lateral areas. RESULTS: The patients consisted of 4 males and 7 females with an average age of 71.3 +/- 8.4 years (54-82 years). The patients were followed up the patients for an average of 13.9 +/- 2.4 months postoperatively. All patients were satisfied with the outcome, and there were no recurrences. CONCLUSIONS: Quickert suture is a simple and effective method, for correcting lower lid entropion by inducing scar formation with absorbable suture materials, but the effect duration is limited. Because the modified Quickert suture utilizes its own tension with a nonabsorbable suture material, the effect lasts as long as the suture material remains. It is a useful and practicable method for patients, in poor general condition or not wanting extensive surgical procedures.

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.

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 Effect of Involutional Entropion Surgery: Quickert-Rathbun Suture

PURPOSE: To evaluate the effectiveness of the Quickert-Rathbun suture to correct involutional entropion. METHODS: A retrospective review was performed of 132 consecutive patients (132 lids, male 58, female 74) with involutional entropion who underwent correction from September 2001 to June 2004 at Kim's eye hospital. All surgical corrections were performed with the Quickert-Rathbun suture technique. The average follow-up period was 9 months (1~17 months). RESULTS: The average length of follow-up time was 14 months (6~22 months). There were no long-term complications like lagophthalmos or ectropion. Surgery was successful in 102 (77.2%) of the 132 eyelids in the first Quickert-Rathbun suture. The second Quickert-Rathbun suture was performed to 17 out of 30 recurred patients, One of whom was noted to have recurrent entropion at 12 months. The final success rate of Quickert-Rathbun suture was 89.3%. The average length of recurrence time was 9.1+/-8.4 months. CONCLUSIONS: The Quickert-Rathbun suture described is simple, straightforward and reliable for the correction of involutional entropion primarily.