Severe cicatricial entropion repair using mucous membrane graft in Stevens–Johnson syndrome

Background: Severe cicatricial entropion in Stevens–Johnson syndrome (SJS) patients is difficult to treat and is associated with a higher recurrence rate. Also, entropion in the presence of lid margin mucous membrane graft (MMG) further complicates the surgical anatomy and approach. Purpose: To report a modified surgical technique of repairing severe upper eyelid cicatricial entropion in an SJS patient with history of lid margin MMG. Synopsis: Cicatricial entropion in patients with SJS is entirely different from trachomatous cicatricial entropion. The involvement of the lid margin with keratinization, tarsal scarring, persistent conjunctival inflammation, and unhealthy ocular surface affects the surgical approach and outcomes. Conjunctiva?sparing surgery with reconstruction of the lid margin using MMG, flattening and repositioning the anterior lamella, and covering the bare tarsus with MMG rather than leaving it raw are the necessary modifications in this technique from conventional anterior lamellar recession. The video demonstrates the surgical technique for harvesting and preparation of a labial MMG, the splitting of the anterior and posterior lamella of the lid margin, scar tissue release between the lash line and the tarsus, repositioning of the anterior lamella, and anchoring of the labial MMG. Highlights: Anterior lamellar recession combined with MMG wrapping the lid margin and bare tarsus offers good cicatricial entropion repair outcomes. Removal of fat and submucosa from the mucosal graft should be done for better cosmesis. Adequate separation of the scar tissues from the lash line and the tarsus is essential.

Efficacy of two surgical approaches in correction of severe upper eyelid cicatricial entropion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the efficacy of two surgical approaches that microscopical Hotz combined with eyelid margin incision and flap translocation and pure Hotz method in correction of severe upper eyelid cicatricial entropion. <p>METHODS: Totally 84 eyes of 60 patients who underwent corrective surgery for upper eyelid trichiasis between July 2017 to July 2019 were retrospectively assessed. The patients in trial group(32 cases, 42 eyes)underwent the surgical procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope, the other group(28 cases, 42 eyes)were treated with Hotz method. The follow-up time was 12mo. Subjective symptoms, eyelid marginal position, eyelash eversion and patient satisfaction were recorded.<p>RESULTS: The surgery time of one eye in trial group was longer than that in control group(40.8±2.57min <i>vs</i> 28.5±2.64min, <i>P</i><0.01). The cure rates of 1 and 12mo in trial group were 100% and 95%, respectively. And those in control group were 95% and 76%, respectively. The cure rate of 12mo in trial group was higher than that of the control group(<i>P</i>=0.013). There was no significant difference in patient satisfaction between the two groups at 1mo after surgery(<i>Z</i>=1.1825, <i>P</i>=0.2371). 12mo after surgery, patient satisfaction in the trial group was higher than that in the control group(<i>Z</i>=3.7346, <i>P</i><0.01).<p>CONCLUSION: While it spents longer time, the procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope is reasonably successful and satisfactory in rectifying severe upper eyelid cicatricial entropion. It offers more higher cure rate than Hotz alone at long time after operation.

The Correction of Cicatricial Entropion of Upper Eyelid by Tarsal Fracture and Anterior Lamellar Reposition

PURPOSE: To evaluate the surgical results of tarsal fracture and anterior lamellar reposition in patients with cicatricial entropion. METHODS: The authors retrospectively analyzed the medical records of 9 patients (11 eyes) who had undergone tarsal fracture and anterior lamellar reposition for cicatricial entropion from October 2003 to September 2008. RESULTS: 6 eyes of 5 patients were male and 5 eyes of 4 patients were female. The patients' mean age was 63.4 (43.5~75.9) years. The mean follow-up period was 29.9 (7~67.6) months. After surgery, the ocular irritation disappeared in all patients. There were no recurrences or complications. CONCLUSIONS: Tarsal fracture and anterior lamellar reposition in patients with cicatricial entropion is a simple and cosmetically effective procedure without complications.

Tarsal Margin Rotation with Blepharoplasty to Correct Cicatricial Entropion of The Upper Eyelid

PURPOSE: To report the efficacy of tarsal marginal rotation with blepharoplasty in the management of cicatricial entropion of the upper eyelid. METHODS: In 9 consecutive patients, 14 eyelids with moderate cicatricial entropion of the upper eyelid were enrolled in this study. All 14 eyelids underwent tarsal margin rotation with blepharoplasty. In cases where one eyelid was involved, the fellow eyelid underwent upperlid blepharoplasty at the same time. The mean follow-up period was 17.7 months (range, 11 to 53 months). RESULTS: In all 14 upper eyelids, the eyelashes rotated away from the surface of the eye postoperatively. There was not recurrence in 13 eyelids and the effect of correction was maintained for the follow-up period. However, in one eyelid the cicatricial entropion recurred after months. Tarsal margin rotation was repeated and there was no recurrence for 6 months. CONCLUSIONS: Tarsal margin rotation with blepharoplasty appears to be effective in managing cicatricial entropion of the upper eyelid in both functional and cosmetic aspects.

Management of Severe Cicatricial Entropion Using Shared Nasal Turbinate Mucosal Graft

PURPOSE: Nasal turbinate mucosal graft provides an appropriate sturdiness and smooth mucosal surface and has added benefit of mucus production. We report one case of correction of severe upper and lower cicatricial entropion with shared nasal turbinate mucosal graft procedure. METHODS: A 40-year-old male patient who had past medical history of Stevens-Johnson syndrome in his early twenties had severe upper and lower cicatricial entropion and trichiasis irritating the cornea. We corrected the severe upper and lower entropion simultaneously with shared inferior nasal turbinate mucosal graft. RESULTS: A successful correction of severe upper and lower cicatricial entropion and improvement of dry eye symptom by plentiful mucus secretion were achieved and there was no recurrence during the followup of 14 months. CONCLUSIONS: We report a case of good anatomical, functional and cosmetic results achieved by shared nasal turbinate mucosal graft procedure in the correction of severe upper and lower cicatricial entropion which cannot be corrected successfully with other conventional methods.

Hard Palate Mucosa Grafts for Cicatricial Entropion

Various surgical procedures have been described for correction of cicatricial entropion of the eyelid. Many of them fail to provide long-term correction and anatomic alteration which is the excessive scarring of the posterior lamella of the eyelid. Hard palate mucosa grafts provide a smooth mucosal surface to the cornea and buttress the scarred tissues of the posterior eyelid. Ten eyelids of eight patients underwent eyelid margin reconstruction using hard palate mucosa graft. Cicatricial entropions were secondary to chemical burn(2 patients), herpes zoster (1 patient), atopic dermatitis (1 patient), toxic epidermal necrolysis (1 patient) and Stevens-Johnson syndrome (3 patients). Surgical results in ten eyelids were satisfactory. The grafts contracted minimaIly, and the palatal donor site healing was completed in 2-4 weeks.

The Effects of Tenzel Operation on Cicatricial Entropion

Tarsus wedge resection and lid margin splitting with recession. Tenzel operation, were performed for cicatricial entropion of seventeen eyelids in twelve patients. The ages ranged from 10 to 68 years(mean, 45.1 years). Seven patients were women and five patients were men. The causes of entropion were chemical burn, thermal burn, ocular pemphigus and previous lid operations All patients were satisfied with good cosmesis, functional results without recurrences and improvement of tearing, ocular pain and photo-phobia after the follow-up period of 3 to 36 months. The advantages of Tenzel operation over other methods were simplicity, excellent cosmetic and functional effects and less recurrence. Therefore, Tenzel operation is recom mended as the method of choice for cicatricial entropion.

A Clinical Study on Implantation of Anterior Chamber Intraocular Lens and Posterior Chamber Intraocular Lens by Scleral Fixation in Eyes without Capsular or Zonular Support

The study was performed retrospectively to compare the results of anterior chamber IOL(Intraocular Lens) implantation and posterior chamber IOL implantation by scleral fixation in cases of inadequate zonular or capsular support during the extracapsular cataract extraction. A total of 27 cases were reviewed of which 11 cases had anterior chamber IOL implantation and 16 cases had posterior chamber IOL implantation by scleral fixation. The follow-up period ranged from two to twenty-four months. Nine of eleven in anterior chamber IOL group and thirteen of sixteen in posterior chamber IOL group had the final corrected vision of 0.5 or better. Vision-threatening complications included two cases of cystoid macular edema in anterior chamber IOL group, whose visual acuity was 0.1 and 0.5, and three cases of vitreous hemorrhage in posterior chamber IOL group, which had little effect on visual outcome The final visual acuity didn't show statistically significant difference between the two groups.

Correction of the Trichiasis and the Cicatricial Entropion by Transposition of Skin Flaps

Trichiasis is usually associated with congenital entropion or conjunctival destruction from disease or injuries. Cicatricial entropion follows scarring of the palpebral conjunctiva, which may be caused by chemical injuries, surgical procedures, trauma and infections. Numerous surgical procedures have been described for correction of trichiasis and cicatricial entropion in accordance with the severity and location of the condition. We have treated partial trichiasis in 2 cases(4 lids),(one involving nasal one forth of the upper lid with corrected congenital ptosis and the other in temporal one forth of the upper lid with narrow palpebral fissure) and cicatricial entropion on the middle one forth of the upper lid in 3 cases(3 lids) with transposition of skin flaps. The resuits were satisfactory.

New Operation Method on the Cicatricial Entropion and the Distichiasis

The term "entropion" is defined as a turning inward of the eyelid. Depending on the mechanism of its causation, it may be classified into four types; mechanical, spastic, senile, and cicatricial. Cicatricial entropion follows scarring of the palpebral conjunctiva, which may be caused by trauma, chemical injuries, infections such as trachoma, benign ocular pemphigus, Stevens-Johnson syndrome, and eyelid surgery. Distichiasis is a rare congenital anomaly in which aberrant separate row of lashes usually composed of hairs smaller than normal, appears along the posterior lid margin. Numerous surgical procedures have been described for surgical correction of cicatricial entropion and distichiasis in accordance with the severity of the condition. We have treated cicatricial entropion in 6 eyes(8 lids) and distichiasis in 3 eyes (3 lids) with sliding tarsoconjunctival grafting, and the results were satisfactory.