Simple effective surgery for involutional entropion suitable for the general ophthalmologist

Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience

PURPOSE

The aim was the comparison of two different approaches to re-insert the inferior eyelid retractors within addition to lateral tarsal strip at lower eyelid involutional entropion (LEIE) surgical correction.

METHOD

This multicentric retrospective case series involved 233 consecutive patients (195 eyelids) who underwent LEIE repair. All the lids had a lateral tarsal strip (LTS) in addition to the reinsertion of retractors onto the tarsal plate via the anterior approach (group 1) or the posterior approach (group 2). The desired normal position of the eyelids at 6-month follow-up was considered 'surgical successes, while entropion recurrence and overcorrection (ectropion) were considered 'surgical failures'.

RESULTS

One-hundred ninety-one (82%) surgeries were included in group 1 and 42 (18%) in group 2. The success rate was 92.1% (176 lids) in group 1 and 85.7% (36 lids) in group 2 (p = 0.188). The recurrence rate was statistically higher for group 2 (14.3%) than for group 1 (3.7%) (p = 0.016). Overcorrection only described in group 1 (3.1%). Both groups had a similar complication rate (p = 0.268), with trichiasis being the most frequent (14, 6%). Ten eyelids (47.6%) from the 21 overall failures were satisfactorily reoperated, and the remaining ones were treated conservatively.

CONCLUSION

The anterior or posterior approach to reinsert lower eyelid retractors to tarsal plate in addition to LTS to correct LEIE can provide a similar outcome. However, the anterior approach achieves a slightly higher success rate with fewer recurrences but with a higher overcorrection rate.

Effect of Resident Involvement in Ophthalmic Surgery on Patient Outcomes: A Systematic Review and Meta-analysis

PURPOSE

To determine the effect of resident- vs attending-led surgeries on patient outcomes in ophthalmic surgery.

DESIGN

Systematic review and meta-analysis.

METHODS

Two independent authors searched PubMed, EMBASE, and Cochrane Library from inception to March 2022. Categorical data from studies were pooled to report odds ratio (OR) and 95% CIs. Continuous data were analyzed to yield standardized mean difference (SMD) and 95% CIs. Propensity-matched studies were analyzed separately. Study quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

Twenty-four studies were included in this meta-analysis. Seventeen of the 20 outcomes had no significant differences between the 2 cohorts. Notably, many critical cataract surgery-related outcomes showed no significant differences, including posterior capsular tear, lens fragment retainment, and retinal detachment. Among propensity-scored studies, the resident-led surgeries had longer operative duration (SMD 0.81, 95% CI 0.29, 1.33; 3 studies [260 patients], I² = 74%) and had an increased risk of an unplanned return to the operating room (OR 2.58, 95% CI 1.31, 5.06; 4 studies [342 patients], I² = 0%). Among 2 non-propensity-scored, resident-led surgeries had increased incidence of choroidal detachment or choroidal effusion (OR 2.28, 95% 1.02, 5.09; 2 studies [401 patients], I² = 19%). No significant difference was found for ocular hypotony. Significant heterogeneity existed among propensity-scored studies.

CONCLUSIONS

Resident-led surgeries appear overall safe, effective, and comparable to attending-led surgeries with respect to commonly encountered perioperative complications. Specific differences in outcomes exhibit significant heterogeneity and small sample sizes, and may be of unclear or equivocal clinical significance.

Lateral Tarsal Strip Complications With and Without Conjunctiva Stripping

PURPOSE

The lateral tarsal strip (LTS) procedure is commonly used to correct eyelid malposition. When performing LTS, some surgeons elect to remove conjunctiva from the tarsal strip, while others do not. It has been hypothesized that without conjunctival stripping, the buried conjunctival tissue can cause complications such as inclusion cysts and granulomas. However, there is limited data comparing LTS cases with and without conjunctiva removal. The authors sought to evaluate whether conjunctival stripping had any impact on complication rates with LTS.

METHODS

LTS operations for ectropion correction were retrospectively reviewed and were separated into 2 cohorts, Con (conjunctiva not removed) or Coff (conjunctival removed). Charts were reviewed for outcomes and complications including inclusion cyst formation, granuloma formation, wound dehiscence, infection, and focal rim tenderness.

RESULTS

The complication rate was 10% versus 8% for Con versus Coff respectively ( p = 0.54). The common complications of LTS surgery were granuloma (4%), wound dehiscence (3%), focal rim tenderness (3%), and infection requiring antibiotics (<1%). There was no significant difference in these complications between the Con and Coff cohorts.

CONCLUSIONS

Complications in both groups were minimal, similar to prior studies, and there was no difference between the 2 cohorts. While it has been suggested that buried conjunctiva may result in increased complication rates, the author's findings suggest that removing the tarsal conjunctiva is a superfluous step in the LTS surgery and does not affect complication rates.

The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery-A review

Introduction

The lateral tarsal strip is one of the basic surgical techniques in ophthalmic plastic surgery. It is used in many indications, predominantly in ectropion repair. Even though there are alternatives, it is probably one of the most popular techniques in ophthalmic plastic surgery. The lateral tarsal strip is also part of bigger surgical procedures (such as midface lifting, entropion surgery, reconstruction surgery, or a part of some surgical approaches to the orbit). The aim of this review is to assess the most common ways of usage of the lateral tarsal strip, to cover its alternatives, and to discuss the future of this technique.

Methods

We have search PubMed and Web of Science and went through articles about lateral tarsal strip. We have also searched for other techniques that used the lateral tarsal strip and included these articles in our review. We have analyzed the major articles and made a review about the topic.

Results

As a natural part of many advanced surgical techniques and as a major surgical technique for lower eyelid ectropion repair, the lateral tarsal strip remains an important part of modern ophthalmic plastic surgery.

Outcomes of Lateral Tarsal Strip in Conjunction with a Minimal Skin Muscle Excision Underlying Cauterization in Korean Patients with Involutional Entropion

We reviewed the medical records of 53 involutional entropion patients, who underwent lateral tarsal strip (LTS) with a minimal skin muscle excision by cauterization from March 2014 to December 2017, to evaluate the effectiveness and efficiency of LTS in conjunction with a minimal skin muscle excision using cautery in patients with involutional entropion. We evaluated the success rate, complications, recurrence rate, and degree of satisfaction of our technique. Of 53 patients, there were 5 bilateral cases for a total of 58 eyelids. The average of age was 71.2 years old (57–90 years). The average follow-up period was 18 months (12–39 months). The success rate for involutional entropion correction was 98.1% with our technique. There was one mild recurrence case at 7 months. In our study, the average operation time was 20.8 min (15–29 min) for 48 unilateral cases and 27.2 min (20–32 min) for 5 bilateral cases without intraoperative complications. Of 42 responders of patients’ satisfaction questionnaire, 38 patients showed good satisfaction and were willing to recommend the surgery to their acquaintances. The technique of LTS with minimal skin excision with cauterization was effective and provided satisfying outcomes to patients with involutional entropion.

Comparison of the Postoperative Outcomes of Posterior Layer Advancement and Modified Iliff Suturing to Correct Involutional Lower Lid Entropion

Involutional lower lid entropion is treated surgically with either incision or rotational suturing. The authors have obtained good results with the modified Iliff suture (MIS) procedure. Here, the authors compare the efficacy and postoperative outcomes of MIS and posterior layer advancement. This study included Japanese patients with a normal snap-back test, who underwent primary surgery for correcting involutional lower lid entropion, performed by the same surgeon, from April 2009 to March 2017, and who were followed up for at least 24 months postoperatively. Posterior layer advancement was performed on 50 eyelids of 48 patients (19 men, 29 women; mean age 74.1 ± 8.7 years) and MIS was performed on 50 eyelids of 40 patients (16 men, 24 women; mean age 77.3 ± 7.5 years). The authors compared the postoperative follow-up duration, recurrence rate, and operating time between groups. Postoperative follow-up duration was 34.5 ± 7.4 months in the posterior layer advancement and 32.3 ± 8.1 months in the MIS group (P = 0.180). Recurrence rate was 6% (3 cases) in the posterior layer advancement group and 4% (2 cases) in the MIS group (P > 0.999). Operating time was significantly shorter in the MIS group (5.8 ± 1.1 minutes) than in the posterior layer advancement group (31.6 ± 4.1 minutes, P < 0.001). Modified Iliff suture is less invasive than posterior layer advancement and has similar postoperative outcomes; thus, it is useful for treating involutional lower lid entropion.

Modified everting sutures combined with reattachment to the inferior tarsal plate for involutional lower eyelid entropion: A new technique

Background

This study evaluated the outcomes of a new modified Wies technique for patients with involutional lower eyelid entropion without horizontal eyelid laxity.

Methods

This case series retrospectively analyzed consecutive patients with entropion who underwent surgery between January 2014 and March 2019 by the same experienced surgeon. Horizontal eyelid laxity, lower eyelid retractor function, and orbicularis muscle overriding were recorded before and after surgery. The recurrence rate and complications were also evaluated. This technique consisted of modified everting sutures combined with reattachment of the lower eyelid retractors to the inferior tarsal plate.

Results

This new technique was performed on 28 eyes in 25 patients (mean age, 71.0±8.0 years; range, 56–87 years). Nine patients (36%) were women and 16 (64%) were men. Lower lid entropion was present in the right eye in 14 patients (56%), the left eye in eight patients (32%), and both eyes in three patients (12%). The mean follow-up period was 27.3±12.4 months (range, 6–60 months). No intraoperative complications were observed. All patients’ symptoms were alleviated. One patient (3.6%) had recurrence after 2 years (success rate, 96.4%). The remaining 27 eyes maintained a satisfactory and comfortable eyelid position. No patients had problems with scarring.

Conclusions

The approach described herein proved to be safe and feasible in eyes with involutional lower eyelid entropion without horizontal eyelid laxity. These advantages of this procedure include the lack of a conjunctival scar, punctal eversion, and lateral canthal angle deformation. A low recurrence rate and a long interval to recurrence were also observed.

A Comparison of Surgical Outcomes of Two Combination Surgeries for Involutional Entropion: Fixing 3 vs 2 Pathologic Components

The purpose of this study was to compare the surgical outcomes of two combinational surgeries for involutional entropion: Inferior retractor tightening (IRT) + lateral tarsal strip (LTS) + skin muscle excision (SME) vs LTS + SME. The authors reviewed the records of 2 groups which were made up of 80 (85 eyelids) and 58 (63 eyelids) involutional entropion patients with 71.4 and 71.8 years on average respectively. The 2 groups were categorized into Group A and Group B by different surgical techniques. The former underwent IRT + LTS + SME surgery between April 2004 and February 2014, while the latter received LTS + SME surgery between March 2014 and February 2018. The authors evaluated the surgical outcomes of 2 combinational surgeries. In Group A, 84 out of 85 (98.8%) lids were successfully corrected and 1 (1.2%) lower eyelid suffered from recurrence during the follow-up period of 26.5 ± 4.6 months. Two canthal deformity cases occurred in this group. In Group B, 62 out of 63 (98.2%) lids were successfully treated and there was 1 (1.8%) case of recurrence during the follow-up period of 21.0 ± 10.0 months. No cases of complications were noted. IRT + LTS + SME procedure took 26.4 ± 2.4 minutes and LTS + SME procedure took 20.6 ± 3.9 minutes (P < 0.001). The LTS + SME technique exhibited a comparable success rate with the IRT + LTS + SME operation. LTS + SME appeared to be significantly faster and safer compared to the IRT + LTS + SME procedure.

Surgical correction of involutional lower lid entropion with lateral canthal eyelid block excision and imbrication of the capsulopalpebral ligament using non-buried non-resorbable imbricating sutures versus buried resorbable imbricating sutures

PURPOSE

To compare the results of surgical correction of involutional lower eyelid entropion using either buried resorbable imbricating sutures or non-buried non-resorbable sutures that were removed after five to seven days.

METHODS

Retrospective analysis of a two-surgeon series. Analysis of the charts of patients surgically treated for involutional lower eyelid entropion between January 2011 and December 2014 with a minimum follow-up of 12 months.

MAIN OUTCOME MEASURES

Recurrence rate, postoperative complications.

RESULTS

We included 281 eyelids of 240 patients. Of these, 89 eyelids had been treated with buried resorbable imbricating sutures (surgeon WvdB) and 192 with non-buried non-resorbable sutures (surgeon DP). Of the 281 eyelids, 77 eyelids had undergone previous entropion surgery. In the buried resorbable suture group (group R), the mean follow-up was 30 months (range 12 to 61 months) versus 39 months (range 14 to 60 months) in the non-buried non-resorbable group (group NR) (p = 0.07). With a follow-up of up to 18 months, the recurrence rate was 2.2% in group R and 4.2% in group NR (p = 0.73). With a similar follow-up, the recurrence rate was 3.9% after primary surgery versus 2.6% in recurrent cases (p = 0.73). Minor postoperative complications and side-effects were seen in 5.3% (15/281).

CONCLUSION

We found no difference in the recurrence rate between the use of buried resorbable imbricating sutures and non-buried non-resorbable sutures and between primary versus recurrent cases. We conclude that we can safely use buried resorbable imbricating sutures in involutional entropion. It yields comparable results and omits the need for suture removal.

Lateral tarsal strip versus Bick's procedure in correction of eyelid malposition

OBJECTIVES

To compare the functional and anatomical outcomes of lateral tarsal strip (LTS) with Bick's procedure in treatment of eyelid malposition.

METHODS

A retrospective, consecutive case series of patients who underwent LTS and Bick's procedure for all types of involutional lower eyelid malposition, at two centers between January 2012 and 2015. Statistical analyses of differences between groups were performed using the Fisher's exact test to compare non-continuous variables and Mann-Whitney U test for continuous variables.

RESULTS

A total of 641 procedures (557 LTS and 84 Bick's) were performed on 504 patients (137 bilateral) by 7 consultants and their trainees. The study cohort included 286 males and 218 females. The mean age was 76.2 years (median 78). The mean follow-up was 13.07 months (median 7, range 0.5-58 months). The indications for surgery included ectropion (43.2%), entropion (39.9%), eyelid laxity (12.3%), floppy eyelid syndrome (2.7%), and others (1.9%). At last follow-up, the LTS group achieved 89.1% anatomical success (total + partial correction) compared to 100% in Bick's group (P < 0.001). Functional improvement was 82% and 95% in LTS and Bick's groups, respectively (P = 0.002). Consultants and trainee doctors achieved comparable outcomes within each group. Complications were relatively minor with no major long-term sequelae, nor any statistically significant difference between the two groups in terms of frequency of adverse events (16.9% vs 14.2%, P = 0.929). The reoperation rate was 9% in the LTS group during the study period, compared to none in the Bick's group (P = 0.001).

CONCLUSIONS

This study compares the outcomes of the largest reported cohort of eyelid malposition surgery analyzing the two different techniques for lid margin shortening. Bick's procedure achieved statistically significant better anatomical and functional outcomes compared to LTS although the samples were unequal and not randomized.

Lateral tarsal strip plus skin-muscle flap excision in the treatment of lower eyelid involutional entropion

This article examines the effectiveness of skin-muscle flap excision in conjunction with a lateral tarsal strip for the treatment of involutional entropion. Ninety-six eyelids in 83 consecutive patients with involutional entropion were treated using a standardized surgical procedure. All patients underwent lower eyelid tightening with a lateral tarsal strip, dissection of a skin-muscle flap inferiorly through a subciliary incision and excision of redundant skin as well as orbicularis muscle. Follow-up data was obtained by retrospective chart review and telephone interviews. 80 patients were included in this study. The only exclusion criteria was failure to attend the 1 week follow-up appointment, n = 3. There was only one recurrence which was mild and revised under local anesthesia. Two patients had overcorrection with mild ectropion but did not require additional surgery. In those that completed their initial post-operative visit, the average time follow-up time was 502 days. Excision of a skin-muscle flap is a useful addition to lateral tarsal strip surgery in the treatment of involutional entropion and is a quick procedure producing excellent functional and cosmetic results. To our knowledge, this is the first cohort of patients to be reported using this technique where all patients had a standardized surgical approach. Additional studies are needed to compare long-term outcomes of this technique against other surgical treatments.

Success rate of nurse-led everting sutures for involutional lower lid entropion

PurposeTo evaluate safety and long-term recurrence rate of entropion in patients having everting sutures (ES) for involutional entropion by ophthalmic nurses in a real clinical setting.Patients and methodsRetrospective notes review of all patients who had an outpatient ES by our trained ophthalmic nurses over 2 year's time period. Outcome measures were complication and recurrence rates. Those with less than 3 years' recorded follow-up were contacted by paper questionnaire.Results90 lids of 82 patients analysed. Mean age was 78 (range 54-97). In total, 82% had no entropion surgery before, whereas 13% had previous ES and 5% one or more other procedures. Questionnaires were sent to 38, with return rate of 81%. Recurrence rate was 21.1% after 36-60 months follow up from nurse-performed ES, with mean time to recurrence of 15 months (SD 13 months). A total of 32% of patients died during the follow-up period. Mean time between the procedure and death is 20.5 months. When ES were repeated twice (11 patients), recurrence rate was still 20%. No patients had any complications.ConclusionES can be safely performed by ophthalmic nurses, with success rate comparable to the same technique performed by ophthalmologists.

Lower eyelid involutional entropion repair with lateral tarsal strip and infraciliary rotation sutures: surgical technique and outcomes

PURPOSE

To describe a novel technique for the surgical repair of involution entropion of the lower eyelid and to evaluate its effectiveness in a series of patients.

METHODS

This retrospective interventional case series includes patients who underwent entropion repair via lateral tarsal strip with infraciliary rotation sutures during a 5-year period by one surgeon. Demographic data was collected and incidence of recurrence was determined.

RESULTS

Forty-four eyelids of 36 patients with involutional entropion underwent surgical repair via lateral tarsal strip plus infraciliary rotation sutures. All patients had successful repair of entropion with no recurrences recorded on follow-up, which ranged from 1 to 67 months.

CONCLUSIONS

Lateral tarsal strip combined with infraciliary rotation sutures is a successful method for the repair of involution entropion of the lower eyelid.

Efficacy of the Quickert procedure for involutional entropion: the first case series in Asia

PURPOSE

To report the efficacy of the Quickert procedure in the first case series of involutional entropion in an elderly Asian population, and to introduce the technique to Asian ophthalmologists including general ophthalmologisits and ophthalmic trainees.

METHODS

We conducted a retrospective review of 13 consecutive patients underwent the Quickert procedure for involutional entropion by occasional eyelid surgeons at Tokushima University Hospital or Mino Tanaka Hospital from September 2003 to April 2010. Demographic data, including gender, age, history of previous eyelid surgery, systemic disease, recurrence of entropion, postoperative complications, and symptoms were analyzed.

RESULTS

There were 5 male (38.5%) and 8 female (61.5%) subjects with a mean age of 77.8 years. Three patients underwent previous surgery for entropion were included. Entropion was rectified in all patients by a single Quickert procedure, and no recurrence was observed for a maximum of 89 months after the surgery. Although notching of the eyelid margin and mild symblepharon were observed in one patient, no symptoms associated with these complications were reported.

CONCLUSION

The Quickert procedure can be one of the surgical procedures of choice for involutional entropion and should be common surgical approach for occasional eyelid surgeons in Asia as well as in western countries.

Why does the corrective procedure of the ectropion work for repairing the entropion?

BACKGROUND

The accepted standard for the correction of involutional entropion has not been well established. This is our search for the reasonable answer for our dilemma. For the correction of involutional entropion, we have applied the modified Kuhnt-Szymanowski-Smith method. It brought the best result compared with other various procedures.

METHODS

This report is a retrospective interventional case series of all consecutive patients with the lower-eyelid involutional entropion. They were operated exclusively by the same author with the modified Kuhnt-Szymanowski-Smith method, which was originally reported for the corrective procedure for ectropion.

RESULTS

In total, 27 patients underwent surgical repair with the modified Kuhnt-Szymanowski-Smith method. There were 15 men and 12 women with a mean age of 77 years (range, 70-91 years). There was no case of recurrence following the primary procedure during 20 months of the mean follow-up period (18-36 months).

CONCLUSIONS

From our experience, this is one of the procedures to be considered for involutional entropion. It is not only safe, simple, and effective but also requires short operative time.

A systematic review of the effects of residency training on patient outcomes

BACKGROUND

Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.

METHODS

The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.

RESULTS

Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.

CONCLUSIONS

The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.

Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population

PURPOSE

To determine the prevalence of involutional entropion and ectropion of the lower eyelid in the elderly population; to examine how these disorders are related to gender, age, skin color, and axial ocular globe projection; and to define the incidence of associated ocular surface and pathologic eyelid findings.

METHODS

An ophthalmic survey was conducted in 24,565 elderly people. All participants underwent ophthalmic examination by general ophthalmologists to identify entropion and ectropion. Information about associated ocular surface and pathologic eyelid findings were collected from all patients with involutional eyelid malposition. Patients with involutional entropion and ectropion underwent measurements of the axial ocular globe projection. The Pearson chi-square test and the Mann-Whitney U test were performed.

RESULTS

The prevalence of involutional entropion was 2.1%; 1.9% in men and 2.4% in women. The prevalence of involutional ectropion was 2.9%; 5.1% in men and 1.5% in women. Dry eye syndrome, lower retractor laxity, and superficial punctate keratopathy were seen significantly more often in patients with involutional entropion than in those with involutional ectropion (p < 0.001). Chronic conjunctivitis was significantly more common in patients with involutional ectropion than in those with involutional entropion (p < 0.001). The axial ocular globe projection was significantly smaller in patients with involutional entropion than in those with involutional ectropion (p < 0.001).

CONCLUSIONS

The prevalence of involutional entropion and ectropion in the elderly population is 2.1% and 2.9%, respectively. The axial ocular globe position plays a pathogenic role in involutional lower eyelid malposition.

Pathogenesis of involutional ectropion and entropion: the involvement of matrix metalloproteinases in elastic fiber degradation

PURPOSE

To determine the elastic fiber content and ultrastructure as well as the expression of elastin-degrading enzymes in biopsy specimens from patients with involutional ectropion and entropion.

MATERIALS AND METHODS

Twenty consecutive patients with involutional ectropion (group 1) and twenty consecutive patients with entropion (group 2) were matched with twenty control patients (basal cell carcinoma) regarding age and gender. Full-thickness eyelid resections performed in study and control patients were examined by light and transmission electron microscopy, computer-assisted measurements, and immunohistochemistry using antibodies against matrix metalloproteinase (MMP)-2, MMP- 7, and MMP-9. The Kruskal-Wallis test and the Pearson chi-square test were performed.

RESULTS

Histopathologic analysis of the surgical specimens from patients with involutional ectropion and entropion showed a significant loss of elastic fibers in the eyelid skin, the pretarsal orbicularis oculi muscle, the perimeibomian tarsal stroma, and the intermeibomian tarsal stroma (P < 0.001). Residual elastic fibers revealed an abnormal ultrastructure. Immunohistochemistry demonstrated a significant overexpression of MMP- 2, MMP-7, and MMP-9 in the eyelid skin, the pretarsal orbicularis oculi muscle, the perimeibomian tarsal stroma, the intermeibomian tarsal stroma, and the conjunctiva in groups 1 and 2 compared to controls (P < 0.001).

CONCLUSIONS

The present findings indicate that upregulation of elastolytic enzymes contributes to elastic fibre degradation in patients with involutional ectropion and entropion.

The correction of involutional entropion of eyelid by lateral strip procedure

Aim:

To determine cosmetic and functional outcome following lateral strip procedure (LSP) for involutional entropion.

Materials and Methods:

This study was a prospective analysis of 15 patients (20 eyelids) of involutional entropion, who needed surgical repair. After thorough evaluation, the surgical treatment (LSP) was done in all 15 patients.

Results:

Cosmetic and functional outcome was excellent in all cases following LSP. No complications and recurrence were encountered in any case.

Conclusions:

LSP is simple, physiologic, easy and quick to perform as OPD procedure for involutional entropion under local anesthesia without hospitalization by a general ophthalmologist.