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Auguste LA, Nghiem AZ, Vahdani K. Horizontal eyelid shortening alone versus combined procedures for the correction of involutional lower eyelid entropion. Int Ophthalmol 2023; 43:4979-4983. [PMID: 37815678 DOI: 10.1007/s10792-023-02900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Conventionally, management of involutional entropion involves correcting both vertical and horizontal laxity, however the optimal surgical approach is debated. OBJECTIVE To compare the recurrence rate of horizontal lower eyelid shortening alone with combined surgical approaches for correction of involutional lower eyelid entropion. METHODS AND MATERIAL A retrospective, comparative, consecutive case series of patients undergoing surgery for involutional lower eyelid entropion with both horizontal and vertical laxity. Patients were categorized based on the procedure as: Group 1, horizontal shortening alone, Group 2, horizontal shortening with everting sutures), and Group 3, horizontal shortening with retractor plication. RESULTS Of the 249 procedures (31 bilateral) performed on 218 patients, 54 (22%) involved horizontal eyelid shortening alone (Group 1), while 80 (32%) had this combined with everting sutures (Group 2), and 115 (46%) with retractor plication (Group 3). The anatomical success rates for Groups 1, 2, and 3 were 93, 94, and 90% (P = 0.69), respectively. Similarly, reported symptom improvements were 94, 93, and 93% for these groups (P = 0.91). After an average follow-up of 15.7 months (median 10; range 6-81), Group 1 (eyelid shortening alone) had a 7% (4/54) recurrence, compared to 8% (16/195) in Groups 2 and 3 (combined procedures) (P = 1.0). Complications were minor, with no significant difference between groups. CONCLUSION Eyelid shortening alone appears to be as effective as combined techniques for involutional entropion with both horizontal and vertical eyelid laxity. Nevertheless, procedure selection should consider primary pathogenic factors.
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Affiliation(s)
- Lillian A Auguste
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Allan Z Nghiem
- Adnexal Department, Moorfields Eye Hospital NHS Trust, London, EC1V 2PD, UK
| | - Kaveh Vahdani
- Adnexal Department, Moorfields Eye Hospital NHS Trust, London, EC1V 2PD, UK.
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Al-Mujaini AS, Ul Kadir SM, Maurya RP. Outcomes of combined procedures compared to various single techniques for involutional entropion. Oman J Ophthalmol 2023; 16:439-445. [PMID: 38059104 PMCID: PMC10697267 DOI: 10.4103/ojo.ojo_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/19/2023] [Accepted: 08/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND To describe the outcomes of triangular tarsectomy and limited orbicularis myectomy with lower eyelid retractor plication compared to an everting sutures (ES) technique or lateral tarsal strip (LTS) procedure for the correction of lower eyelid involutional entropion. METHODS A nonrandomized clinical study was carried out at two tertiary eye hospitals between January 2016 and December 2019. Patients in Group A underwent triangular tarsectomy and limited orbicularis myectomy with lower eyelid retractor plication. Group B had ES, and Group C underwent a LTS procedure. All participants were operated by one surgeon and underwent 1-year follow-up. RESULTS A total of 78 patients in whom 84 eyelids were affected by lower eyelid involutional entropion were included in the study. The success rate was higher in Group A compared to Group B and Group C (100% vs. 86.7% vs. 95.8%; P < 0.05). Recurrence at a 1-year follow-up was noted in only four (13.3%) eyelids in Group B and one (4.2%) in Group C. However, patient's in Group C experienced a higher frequency of minimal postoperative complications, including short-term pain (100%), tenderness on the lateral canthal area (100%), tightness of the eyelid (91.7%), and ecchymosis (54.2%) compared to Group A. Patients of Group B experienced minimal or no postoperative complications. CONCLUSIONS Triangular tarsectomy and limited orbicularis myectomy with eyelid retractor plication may be considered the standard procedure for correcting lower eyelid involutional entropion with no recurrence compared to LTS technique or minimally invasive and cost-effective ES procedure.
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Affiliation(s)
- Abdullah S. Al-Mujaini
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Syeed Mehbub Ul Kadir
- Department of Ophthalmology, Sheikh Fazilatunnesa Mujib Eye Hospital and Training Institute, Gopalgonj, Bangladesh
| | - Rajendra Prakash Maurya
- Department of Ophthalmology, Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Huang Q, Fang Y, Wang Y, Liao H. Comparison of the cutaneous orbicularis oculi excision treatment with the inferior eyelid margin fixation treatment for congenital lower eyelid entropion. Int Ophthalmol 2023:10.1007/s10792-022-02610-0. [PMID: 36604394 DOI: 10.1007/s10792-022-02610-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To modify the traditional surgical approach to treat patients diagnosed with congenital lower eyelid entropion using inferior eyelid margin fixation of the orbicularis eyelid muscle. METHODS Ninety-six participants (180 eyes) with congenital lower eyelid entropion diagnosed between January 2019 and April 2021 were included in this study. The patients were divided into Group A (cutaneous orbicularis oculi excision treatment) and Group B (inferior eyelid margin fixation treatment). The efficiency and recurrence rate of treatments were used to compare the two treatments. RESULTS There was no significant difference in age, sex, and eyes distribution in both groups. And higher efficiency rate was found in Group B (P < 0.05). And Group A had a higher recurrence rate in the follow-up after surgical treatment (P < 0.05). CONCLUSIONS This modified inferior eyelid margin fixation of the orbicularis eyelid muscle treatment is an ideal procedure with a high degree of efficacy and low recurrence rate in patients with congenital lower eyelid entropion.
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Affiliation(s)
- Qin Huang
- Department of Ophthalmology and Plastic Surgery, Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, 463 Bayi Avenue, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Yangbin Fang
- Department of Ophthalmology and Plastic Surgery, Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, 463 Bayi Avenue, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Yaohua Wang
- Department of Ophthalmology and Plastic Surgery, Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, 463 Bayi Avenue, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Hongfei Liao
- Department of Ophthalmology and Plastic Surgery, Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, 463 Bayi Avenue, Donghu District, Nanchang, 330006, Jiangxi, China.
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Cai J, Zhou Y, Lv W, Chen W, Cai W, Ng TK, Li Z. Pretarsal orbicularis oculi muscle tightening with skin flap excision in the treatment of lower eyelid involutional entropion. BMC Ophthalmol 2021; 21:435. [PMID: 34911482 PMCID: PMC8675534 DOI: 10.1186/s12886-021-02214-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/10/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To evaluate a modified technique for involutional entropion correction in a retrospective cohort study. METHODS The patients with involutional entropion eyelid were corrected by tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid. The patients received correction surgery from April 2013 to March 2019 were followed up for more than 6 months postoperatively. The outcome measures included the complications and the recurrence rates. RESULTS Total 152 patients (169 eyes) were included. The mean follow-up period was 29.6 months (range: 6-36 months). Postoperative ectropion (over-correction) was observed in 1 patient with 1 eyelid (0.59%); yet, no further surgery was needed for this patient. Recurrence of entropion was found in 1 patient (0.59%). The patient with recurrent entropion received repeated surgery with the same method and achieved a good eyelid position. CONCLUSIONS This study demonstrated that tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid could be an effective surgical method to correct lower eyelid involutional entropion. This method is technically easy with a low recurrence rate and not associated with significant complications in Asians.
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Affiliation(s)
- Jianhao Cai
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Yuansheng Zhou
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Wenjuan Lv
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Wenxia Chen
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Weihao Cai
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Zeyi Li
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China.
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Vydláková J, Tesař J, Krátký V, Šín M, Němec P. LATERAL TARSAL STRIP TECHNIQUE IN CORRECTION OF EYELID ECTROPION AND ENTROPION. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2021; 77:73-78. [PMID: 33985336 DOI: 10.31348/2021/10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Ectropion and entropion are eyelid malpositions associated with a number of unpleasant symptoms. One of several surgical methods that can correct these problems is referred to as the lateral tarsal strip technique. In this paper, we evaluate the postoperative results and quality of this technique. We also examine the complications associated with this surgical method. METHODS The study took place from April 2018 to April 2020 at the Military University Hospital in Prague. The operation was performed by two surgeons. The study included 43 eyes of 33 patients (17 women and 16 men), average age was 79 years. Before the operation, 23 eyes were affected by ectropion and 20 eyes affected by entropion, 35 of the 43 were cases of involutional origin. The study does not include patients who underwent other surgical techniques. RESULTS There were no perioperative or postoperative complications in the entropion surgery group. Successful correction was achieved, and adverse symptoms disappeared in 91.3% of cases. Correct position of the eyelid was not achieved in two cases. For patients with ectropion, surgical correction was successful in 95% of cases. Ectropion persisted after surgery only in one patient. CONCLUSION The lateral tarsal strip technique is a safe, reliable and highly effective surgical technique. Correction of eyelid malposition was achieved in more than 90% of cases. The vast majority of patients were satisfied and reported relief from preoperative symptoms.
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Hu J, Li Y, Li Q, Wang L, Huang Y. A retrospective study of tailored surgery based on the mechanical balance principle for involutional entropion in the lower eyelid. Eur J Ophthalmol 2020; 31:3418-3424. [PMID: 33356531 DOI: 10.1177/1120672120984398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Involutional entropion in the lower eyelid is one of the most common eyelid disorders of the elderly. Despite the effectiveness of the widely used surgical procedures, recurrence rates have failed to improve. In this retrospective study, we aimed to assess surgical plans, effectiveness and safety of tailored surgery based on the mechanical balance principal in treating involutional entropion in the lower eyelid. METHODS A retrospective analysis of 47 patients (54 eyelids) diagnosed with involutional entropion in the lower eyelid and receiving tailored surgical treatment based on mechanical balance principle from 1 January 2016 to 31 December 2018 was carried out. Tailored surgical plans were developed according to the mechanical balance analysis of vertical, horizontal and sagittal directions. RESULTS All 54 eyelids with involutional entropion in the lower eyelid underwent advancement of the lower eyelid retractor (LER) through the conjunctiva. For patients with mild horizontal eyelid laxity, only LER advancement was performed. For moderate and severe horizontal eyelid laxities, combined horizontal reinforcement procedures were performed, including lateral canthopexy, lateral tarsal strip (LTS) surgery and wedge resection. The orbicularis oculi muscle (OOM) tightening or transposition was performed for OOM overriding. The follow-up time was 1 to 4 years, and there were no cases experiencing recurrence. Thus, the rates of effectiveness and recurrence were 100% and 0%, respectively. CONCLUSIONS This is the first descriptive study on the tailored surgical strategies designed according to the mechanism of mechanical imbalance involved in involutional entropion. Tailored surgery based on the mechanical balance principle is safe and effective with low recurrence.
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Affiliation(s)
- Jian Hu
- Medical School of Chinese PLA, Haidian, Beijing, China.,Department of Ophthalmology, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Yueyue Li
- Medical School of Chinese PLA, Haidian, Beijing, China.,Department of Ophthalmology, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Qian Li
- Medical School of Chinese PLA, Haidian, Beijing, China.,Department of Ophthalmology, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Liqiang Wang
- Medical School of Chinese PLA, Haidian, Beijing, China.,Department of Ophthalmology, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Yifei Huang
- Medical School of Chinese PLA, Haidian, Beijing, China.,Department of Ophthalmology, Chinese PLA General Hospital, Haidian, Beijing, China
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Affiliation(s)
- Farida Hakim
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
| | - Paul O Phelps
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States; Division of Ophthalmology, Northshore University HealthSystem, 2050 Pfingsten Rd., Ste. 280, Glenview, IL 60026, United States.
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Comments on: Randomized Controlled Trial Comparing Everting Sutures with a Lateral Tarsal Strip for Involutional Lower Eyelid Entropion. Ophthalmol Ther 2020; 9:365-367. [PMID: 32096142 PMCID: PMC7196106 DOI: 10.1007/s40123-020-00238-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Indexed: 11/29/2022] Open
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Response to Comments on Randomized Controlled Trial Comparing Everting Sutures with a Lateral Tarsal Strip for Involutional Lower Eyelid Entropion. Ophthalmol Ther 2020; 9:369-370. [PMID: 32100201 PMCID: PMC7196099 DOI: 10.1007/s40123-020-00240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 11/10/2022] Open
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