A randomized controlled trial comparing everting sutures with everting sutures and a lateral tarsal strip for involutional entropion.

OBJECTIVE: To determine whether there is a statistically significant difference in the surgical outcome of everting sutures (ES) alone versus everting sutures with a lateral tarsal strip (ES+LTS) in the treatment of involutional entropion. DESIGN: Prospective randomized comparative trial. PARTICIPANTS: Sixty-three patients with primary involutional lower eyelid entropion were enrolled in the study. The age range was 54 to 94 years, with a mean age of 77 years. Baseline characteristics of the comparative groups were similar. METHODS: Patients requiring primary surgical repair for involutional entropion were selected, and those providing informed consent were randomized for surgery. Thirty-six patients were randomized to ES alone, and 27 patients were randomized to ES+LTS. Patients were evaluated at 3 weeks and 6, 12, and 18 months postoperatively. MAIN OUTCOME MEASURES: Successful surgery was defined as a normal eyelid position at rest and inability to induce entropion on tetracaine provocation testing at or before the 18-month follow-up visit. RESULTS: Eight patients were lost to follow-up (7 had ES alone). Of the 55 patients with complete follow-up data, there were 6 failed procedures in the patients who underwent ES alone and no failed procedures in the patients who underwent ES+LTS (P = 0.02). CONCLUSIONS: These data provide strong evidence that success rates at 18 months are higher in patients treated with ES+LTS procedure compared with ES alone.

Graves' disease associated with primary systemic sclerosis.

Graves' disease can be associated with other autoimmune disorders. Primary systemic sclerosis (PSS) is such a disease characterised by multi-organ fibrosis. Abnormal thyroid antibody titres and hypothyroidism as well as hyperthyroidism have been observed in PSS patients. Specific and idiopathic inflammatory disorders are an important differential diagnosis in Graves'orbitopathy (GO). Mycophenolate mofetil (MM) is an immunosuppressive drug which depletes guanosin nucleotides in proliferating B-and T-lymphocytes. We describe the effect of MM on the endocrine orbitopathy of a patient with PSS.