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.

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.

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.

Transconjunctival repair for involutional entropion

PURPOSE: We studied the surgical outcome and efficacy of transconjunctival repair for involutional entropion. PATIENTS AND METHOD: We retrospectively analyzed a total of 20 eyelids of 19 patients with involutional entropion from March 1998 to December 2001. There were 10 male and 9 female patients with the mean age 70 years. It included 2 recurred cases of unknown original surgical procedure. The conjunctiva was cut and opened by monopolar cautery and the conjunctival flap was carefully dissected. Disinserted or attenuated lower lid retractor was fixed by interrupted sutures on anterior part of tarsus. In all patients, full-thickness everting mattress sutures including conjunctiva and lower lid retractor were applied. Lateral tarsal strip procedure was added to 12(60%) eyelids having serious horizontal laxity. RESULTS: Capsulopalpebral fascia was found to be disinserted in 18 eyelids (90%) intraoperatively. Mean follow-up period was 14.1 months (2~24 months). There was no postoperative complication except 1 patient having filamentary keratitis. There was recurrence of entropion in 1 eyelid (5%) at 2months. CONCLUSIONS: The transconjunctival repair for involutinal entropion is simple and effective without singificant complication. The procedure averts the postoperative morbidity, scar of the eyelid and shortens operative time.

Correction of Involutional Entropion by the Amount of Lower Eyelid Laxity

Authors have analysed a series of involutional entropion placed into two categories, those with and without increased horizontal lid laxity following preoperative assessment. Of the 30 entropion operations on 25 eyes, 14 operations(on 13 eyes) were for the group without horizontal lid laxity and 16 operations(on 12 wyws) with horizontal lid laxity. In patients with tight eyelids, we performed lower retractor tucking and excision of preseptal orbicularis muscle and in patients with increased horizontal lid laxity, we added horizontal eyelid shortening procedure to the above procedures. The success rate was 92.8%(13 eyes/14eyes) in group without eyelid laxity, the total surgical success rate being 96.6%(29 eyes/30 eyes).

Surgical Correction of Involutional Entropion

The pathophysiologic changes that lead to involutional entropion are Weakness of the lower lid retractors, Upward migration of preseptal orbicularis over pretarsal orbicularis and forward rotation of lower border of tarsal plate, Horizontal lid laxity from involutional changes of medial and lateral canthal ligament and Enophthalmos from atrophy of the orbital fat with age. In the correction of involutional entropion, the first three factors must be considered for adequate correction. Hsu and Lieu reported Pretarsal orbucularis oculi muscle fixation method for the correction of involutional entropion. Authors performed this method in the 20 patients with involutional entropion of thirty-one eyelids and the results were sucessful.

Surgical Treatment of Involutional Entropion

The orbicularis oculi muscle transpositions with horizontal shortening procedures were performed for involutional entropion of the fourteen lower eyelids in twelve patients. The age ranged from 51 to 84 years (average 66.9 years). One patient was man and eleven patients were women. All patients were satisfactory with good cosmesis and improvement of tearing, discharge and ocular pain etc. after the follow-up period of 6 to 26 months. But mild subcutaneous hematoma of the eyelid was noticed in 3 cases with good absorption.

Correction of Involutional Entropion by the Bowlegs Procedure

Generally accepted mechanisms of involutional entropion are as follows: 1. dysfunction of the inferior eyelid retractors, 2. migration of the preseptal orbicularis fibers upward, 3. reduced support of the lower lid against glove due to enophthalmos, 4. reduced horizontal support because of involutional changes in the lateral and medical canthal tendons. Sanford D. Hecht reported that the above four problems could be corrected simply and successfully by a full thickness excision of Bowlegs shape(Pentagon-shape). Five eyelids of involutional entropion were treated by the Boelegs procedure. The results were successful.

Correction of Involutional Entropion by the Bowlegs Procedure

Generally accepted mechanisms of involutional entropion are as follows: 1. dysfunction of the inferior eyelid retractors, 2. migration of the preseptal orbicularis fibers upward, 3. reduced support of the lower lid against glove due to enophthalmos, 4. reduced horizontal support because of involutional changes in the lateral and medical canthal tendons. Sanford D. Hecht reported that the above four problems could be corrected simply and successfully by a full thickness excision of Bowlegs shape(Pentagon-shape). Five eyelids of involutional entropion were treated by the Boelegs procedure. The results were successful.