[Outcomes of amniotic membrane grafting in surgery for severe upper lid cicatricial entropion]

To evaluate the efficacy of amniotic membrane [AM] grafting in surgery for severe upper lid cicatricial entropion. This randomized clinical trial was performed on both upper eyelids of 22 patients with severe cicatricial entropion. On one side the anterior and posterior lamellae were split and the anterior lamella was recessed. On the other side, the same procedure was done but bare tarsus was covered with AM. Patients were evaluated one day, one and two weeks, and one and three months after surgery. The mean follow-up period was 9.89 +/- 6.17 [range 4-21] months. Overall, 22 patients [13 women and 9 men] aged 55 to 84 years [mean age, 71.54 +/- 8.58] entered the study. The cause of cicatricial entropion was old trachoma in 18 [81.8%] and idiopathic in 4 [18.2%] subjects. In second week, eyelids with AM stained less with fluorescein than the control group [P= 0.016]. At the end of the first month, all lids were epithelialized. There was no significant difference between the two groups in the number of lids with recurrent trichiasis but the number of lashes in contact with the globe in the AM group was significantly lower than the controls [P= 0.042]. There was no significant difference in tarsal shrinkage and normalization of bare tarsus between the study groups. Subgraft hemorrhage occurred in 3 cases in the first week which completely resolved by one month. AM is a useful tissue which can enhance reepithelialization of bare tarsus and may be considered as an adjunct in lid split entropion surgery

Blepharotomy versus Tarsotomy in Upper Eyelid Cicatricial Entropion

To determine the success rate and complications of blepharotomy and tarsotomy in moderately severe upper eyelid cicatritial cntropion.This randomized clinical trial was conducted on patients with moderately severe cicatritial cntropion. The patients were followed for six months and the results and complications were evaluated. Success was defined as uncontacted eyelid margin and cilia to cornea. Sixty upper eyelids of 37 patients [10 male and 27 female] underwent blepharotomy in 30 eyelids and tarsotomy in 30 other eyelids. Mean age was 68.7 +/- 7.0 years in the blepharotomy group and 61.2 +/- 14 in the tarsotomy group. [P=0.3] Trachoma was the undelying cause in all eases. Success rate was 93.3% in the blepharotomy group and 96.7% in the tarsotomy group. [P=0.5] There was no significant difference between the two groups regarding complications of the procedures at the end of follow up except for eyelid notching which was significantly greater in the blepharotomy group. [16.7% vs 0, P=0.02] Blepharotomy and tarsotomy are successful operations in moderately severe cicatritial entropion. Tarsotomy is easier and doesn't need a skin incision. We suggest tarsotomy as a better technique in patients with moderately severe trachomatic cicatritial entropion of the upper eyelids