ABSTRACT
ABSTRACT Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.
RESUMO Objetivo: Descrever uma técnica de rotação marginal superior para a correção do entrópio cicatricial combinando incisão via sulco palpebral, tarsotomia e tração na lamela anterior sem o emprego de suturas externas. Métodos: Técnica cirúrgica. Os passos críticos da cirurgia incluem exposição completa da superfície anterior do tarso até a linha dos cílios e tarsotomia horizontal a 3 mm da margem palpebral, produzindo dois segmentos tarsais, marginal e distal. O fragmento distal é avançado sobre o marginal por meio de 3 suturas biagulhadas absorvíveis 6.0 passadas entre a margem do segmento tarsal distal e o músculo orbicular marginal. Dessa maneira, além da superposição tarsal as suturas tracionam o orbicular marginal evertendo simultaneamente a margem palpebral e a linha ciliar. Nenhum fio é exteriorizado. O retalho pretarsal miocutâneo era fechado com suturas de catugt 6,0. Resultados: Resultados: A técnica descrita foi utilizada em hospital terciário na Arábia Saudita, em 2013 e 2014. Sessenta pálpebras superiores de 40 pacientes (23 mulheres e 17 homens) foram operadas. A idade dos pacientes variou de 44 a 99 anos (média= 70,9 ± 13,01 anos). A cirurgia foi bilateral em 21 pacientes. O seguimento variou de 1 a 12 meses (média= 3,0 ± 2,71 meses). Em 24 pálpebras (40%) o seguimento foi superior a 3 meses. A posição da margem palpebral foi considerada boa em todos os casos. Somente 1 paciente com entrópio unilateral apresentou recidiva da triquíase (2 cílios). Conclusão: A margem palpebral de pacientes com entrópio cicatricial pode ser evertida utilizando-se incisão no sulco palpebral e suturas internas. A técnica descrita combina os princípios das cirurgias de Wies e Trabut e tem como principais vantagens incisão cosmética no sulco palpebral e o não uso de suturas externas. Adicionalmente, o acesso pelo sulco palpebral permite a correção de condições associadas, como dermatocálase, ptose ou retração palpebral.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Entropion/surgery , Eyelids/surgery , Suture Techniques , Trachoma/surgery , Cicatrix/surgery , Medical Illustration , Reproducibility of Results , Rotation , Time Factors , Treatment Outcome , Trichiasis/surgeryABSTRACT
Oman is at the threshold of eliminating blinding trachoma. We conducted a community-based survey in 2009-10 to study the association of trachomatous trichiasis [TT] status with visual acuity and blindness among the Omani population aged 40+ years. A total of 8191 eyes were examined and participants' demographic data were collected. TT was absent in 7890 eyes but 227 of these eyes had had lid surgery for TT in the past. TT was detected in 301 eyes, for the first time in 154 eyes and following lid surgery in 147 eyes. The rate of blindness was significantly lower in eyes that had undergone lid surgery in the past [OR = 0.54]. In regression analysis the predictors of blindness were participant's age [adjusted OR = 1.01], sex [aOR = 2.01], history of lid surgery [aOR = 3.09] and residence in a hyperendemic trachoma area [aOR = 10.6]. Promotion of TT surgery might be beneficial in reducing blindness
Subject(s)
Humans , Male , Female , Trichiasis/surgery , Trachoma , Vision Disorders , Visual Acuity , Blindness , Cross-Sectional StudiesABSTRACT
Background: Community-based lid surgery for trachomatous trichiasis (TT) is provided in 8 local government areas (LGAs) of Sokoto state since 2003 as part of a trachoma control programme. This study aims to assess the impact of community-based lid surgery on the magnitude of TT in 3 LGAs of Sokoto state. Materials and Methods: A population-based survey was conducted in persons aged 15 years and above. A stratified multistage cluster sampling with probability proportional to size was used. Trachoma was assessed using the WHO simplified grading system. Results: Despite high (13) refusals; 72of the minimum sample size was examined. The prevalence of blindness ranged from 1.3to 2.5in the LGAs while the prevalence of TT in persons aged 15 years and above was 2in the Silame; 2.7in the Wamakko and 5.6in the Kware LGAs; respectively. The prevalence of TT in females 15 years and above was 1.1in the Silame; 4in the Wamakko and 6.3in the Kware LGAs; respectively. The trichiasis surgical coverage is 9.5in the Kware and 12.5in the other LGAs respectively. The minimum number of TT lid surgery required to achieve the elimination level is 873 in the Silame LGA; 2611 in the Wamakko LGA and 4672 in the Kware LGA. Conclusion: The burden of TT is high in the study communities while the trichiasis surgical coverage is low. There is a need to strengthen the control programme to meet up with existing need