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Zloto O, Shah P, Paiusco V, Singh B, Kang S, Verity D, Fabiola M. The Outcomes of Involutional Ptosis Surgeries in a Single Tertiary Center. Curr Eye Res 2024; 49:325-329. [PMID: 37921352 DOI: 10.1080/02713683.2023.2277137] [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: 09/04/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To report the surgical outcome of anterior approach primary ptosis surgery in a tertiary center and to compare redo surgical rates between different grades of surgeons. METHODS This is a Retrospective review of series of annual audits. All involutional/aponeurosis-disinsertion ptosis surgeries performed at Moorfields Eye-hospital (MEH) between January 01, 2016 and December 31, 2019 were included. Only primary surgery was included. The following data were collected; number of surgeries per year, number of patients, demographics data, grades of surgeons, success rate, redo surgery rate from different grades of surgeons, complications rate and patients' satisfaction. RESULTS During the study period, 1191 ptosis surgery were performed, with 899 (75%) cases being involutional/aponeurosis-disinsertion ptosis. The mean redo surgery rate within one year from the primary surgery was 10.5% and the mean complication rate was 1.0%, with 78.95% of patients reported being satisfied with the results of the surgery, having no difference between surgeon's grades. The redo surgery rate was higher for cases performed by a junior surgeon (fellow/registrar) (64.26%) than by a consultant (38.94%). CONCLUSIONS We report the success rate of a large cohort of primary involutional ptosis surgery performed at the ophthalmic-specialist tertiary center. The success and complication rates are comparable to the literature at 90% and 1%, respectively. Redo surgeries were more frequently required when performed by junior surgeons compared to the consultants, whereas the patient satisfaction level did not differ between different grades of surgeons.
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Affiliation(s)
- Ofira Zloto
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | - Prachi Shah
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | | | | | - Swan Kang
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | - David Verity
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | - Murta Fabiola
- Adnexal Service, Moorfields Eye Hospital, London, UK
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Sakata Y, Uemura K, Nariyama A, Asamura S. Transconjunctival Approach for Involutional Entropion: Suggestions and Drawbacks. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5408. [PMID: 38025620 PMCID: PMC10653595 DOI: 10.1097/gox.0000000000005408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023]
Abstract
Background Most current surgical approaches in involutional lower eyelid entropion (ILLE) repair focus upon lower eyelid retractor (LER), mainly through transcutaneous approaches. We have opted to use the transconjunctival approach because of the hidden postoperative scar and the shortest reach to the LER. Here, based on our experience, we present our suggestions and note some of the drawbacks regarding ILLE repair by the transconjunctival approach. Methods Two surgeons performed entropion repair on 14 eyelids in 13 patients. Repairs were performed by a transconjunctival approach, where a part of the conjunctiva was at first incised with a scalpel, and the conjunctiva and LER were then separated at the lower edge of the tarsus with scissors. The anterior and posterior aspects of the LER were peeled off, and the LER was dissected into sheets. The LER was then fixed to the anterior-inferior border of the tarsus, and the conjunctiva was sutured. No postoperative gauze, tape dressings, or even suture removal were required. Results Mean operating time was 32.6 minutes. Recurrence was observed in one of 14 patients at an average of 6.6 months postoperatively. Conclusions We reported our suggestions and drawbacks of the transconjunctival approach for ILLE repair. We recommend sufficiently detaching the anterior-posterior aspects of the LER and fixing the LER to the anterior-inferior border of the tarsus. Drawbacks of this technique include the possibility of an insufficient correction in cases with a positive pinch test and medial traction test. Conversely, no further treatment or maintenance is required postoperatively.
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Affiliation(s)
- Yasuhiro Sakata
- From Department of Plastic Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
- Department of Plastic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kazuhisa Uemura
- Department of Plastic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Akihiro Nariyama
- Department of Plastic Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shinichi Asamura
- Department of Plastic Surgery, Wakayama Medical University, Wakayama, Japan
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Woźniak-Roszkowska E, Iljin A, Noszczyk B, Antoszewski B. Evaluation of outcomes of lower eyelid entropion and ectropion surgical repair. POLISH JOURNAL OF SURGERY 2023; 96:50-58. [PMID: 38629275 DOI: 10.5604/01.3001.0053.9352] [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] [Indexed: 04/19/2024]
Abstract
<b><br>Introduction:</b> The imbalance of external and internal forces acting on the lower eyelid can result in entropion and ectropion, both of which cause ocular irritation and loss of proper eye protection. Potential complications of untreated cases include recurrent inflammation of the conjunctiva and cornea, conjunctival neovascularization, corneal abrasion or perforation, and ultimately even loss of vision. Although various surgical techniques are used to address this problem, their long-term outcome and effectiveness are still under discussion. </br> <b><br>Aim:</b> To evaluate outcomes of surgery for entropion and ectropion, including a modified Wheeler's method for entropion correction.</br> <b><br>Methods:</b> A non-comparative study (prospective and retrospective groups) included 100 patients operated on in two university hospitals' plastic surgery departments for lower eyelid entropion or ectropion, following formal ethics approval. The prospective group included 50 patients assessed preoperatively and at 3 and 12 months postoperatively. The retrospective group was comprised of 50 patients (2012-2018), whose preoperative documentation and clinical examinations were analyzed. The main outcome measures were change between pre- and postoperative patient-reported symptoms (VAS scale), ectropion/entropion grading scale (EGS/EnGS), quality of life (WHOQOL-BREF), and occurrence of complications.</br> <b><br>Results:</b> The differences in the severity of all symptoms before and after surgery evaluated with the VAS scale were statistically significant in both groups (p <0.05). We observed 6 recurrences (12%) in the prospective group and 9 (18%) in the retrospective group, with minor complications. Very good functional and esthetic postoperative results were confirmed in 70% (79) of the whole group and in 13 patients (81.3%) treated with the modified Wheeler's method. In the prospective group, the Mann- Whitney U test for dependent variables revealed significant improvement in the somatic, psychological, and environmental domains, with no significant change in the social relationships domain.</br> <b><br>Conclusions:</b> The results following entropion/ectropion surgery prove the effectiveness of the methods used. Complementing them with the modified Wheeler's method brought an increase in the number of very good outcomes. Surgery of lower eyelid malposition contributed to reduced symptoms and improved quality of life. The rates of postoperative sequelae were low.</br>.
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Affiliation(s)
- Ewa Woźniak-Roszkowska
- Department of Plastic, Reconstructive and Aesthetic Surgery, Second Chair of Surgery, Medical University of Lodz, Poland, Department of Plastic Surgery, Prof. W. Orłowski Memorial Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Aleksandra Iljin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Lodz, Poland
| | - Bartlomiej Noszczyk
- Department of Plastic Surgery, Prof. W. Orłowski Memorial Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Second Chair of Surgery, Medical University of Lodz, Poland
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Ding J, Hou Z, Li D. Bidirectional tightening of the anterior lamella for involutional lower eyelid entropion. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:313-317. [PMID: 35395213 DOI: 10.1016/j.jcjo.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/05/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Involutional entropion of the lower eyelid is commonly encountered in the elderly population. An ideal surgical method is supposed to address the underlying horizontal and vertical lower lid laxity simultaneously. This study aims to assess the effectiveness of bidirectional tightening of the anterior lamella to correct involutional lower lid entropion. METHODS A prospective, noncomparative interventional case series was conducted from January 2017 to June 2021. Patients with involutional lower eyelid entropion received procedures combining lateral canthus-sparing orbicularis suspension with marginal rotating sutures to tighten the anterior lamella horizontally and vertically. The aesthetic appearance, postoperative complications, and patient satisfaction were evaluated. RESULTS A total of 50 patients (56 eyelids) with a mean age of 73.1 ± 10.5 years were included. The mean follow-up period was 23.7 ± 17.1 months. All patients had immediate resolution of entropion and associated ocular symptoms. There were no recurrences or other major postoperative complications. Mild temporary ectropion was observed in 4 patients (4 eyelids) without the need for surgical intervention. CONCLUSION The procedure of bidirectional anterior lamellar tightening restores the tension balance of eyelid margin. It provides a simple, successful, and less invasive option to treat involutional lower eyelid entropion.
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Affiliation(s)
- Jingwen Ding
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhijia Hou
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dongmei Li
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Pushker N, Agrawal S, Meel R, Kashyap S, Sen S, Bajaj MS. Transconjunctival excision of external angular dermoid cyst: A novel approach. J Plast Reconstr Aesthet Surg 2023; 83:431-437. [PMID: 37315491 DOI: 10.1016/j.bjps.2023.04.078] [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: 07/06/2022] [Revised: 01/15/2023] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To excise external angular dermoid cyst (EADC) by transconjunctival approach and compare the surgical outcomes with the standard transcutaneous approach. DESIGN This was a prospective, pilot, interventional, comparative study. METHODS Patients with EADC with no or minimal fixity to the underlying bone on palpation and limited to eyelid were recruited. Patients were randomized into 2 groups; group 1 included patients with transcutaneous approach, and group 2 included patients with transconjunctival approach. The parameters assessed were intraoperative complications, duration and ease of surgery, postoperative complications, and overall satisfaction. RESULTS Six children with a painless, round lesion in outer aspect of eyelid were recruited in each group. None of the patients had any intraoperative or postoperative complications, including dysfunction of eyelid contour and fold, persistence or late occurrence of lateral eyelid droop, excessive or recurrence of swelling, and ocular surface problems, especially in group 2, but a skin scar though hidden was inevitable in group 1. The duration of surgery was comparable with better ease of surgery in group 1 and a gradual learning curve in group 2. The overall satisfaction scores were significantly better in group 2 (p < 0.0001). In group 1, parents of 5 of 6 patients had to be reassured that the skin scar will fade with time. CONCLUSION Transconjunctival excision of EADC is a viable and novel approach in patients with mobile cyst that is limited to the eyelid with no obvious bony fossa. Main limitations of the approach are that it requires surgical expertize, provides less surgical space, and has a gradual learning curve.
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Affiliation(s)
- Neelam Pushker
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Rachna Meel
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kokubo K, Katori N, Hayashi K, Fujii A, Koike T, Mizuki N, Hayashi A, Maegawa J. Comparison of postoperative recurrence rates between percutaneous and transconjunctival approaches for involutional entropion. J Plast Reconstr Aesthet Surg 2023; 83:16-22. [PMID: 37270992 DOI: 10.1016/j.bjps.2023.04.045] [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: 01/23/2023] [Accepted: 04/11/2023] [Indexed: 06/06/2023]
Abstract
Lower eyelid entropion is the second most common disease seen after ptosis in oculoplastic outpatients. In this study, we performed percutaneous and transconjunctival shortening of the anterior and posterior layers of the lower eyelid retractor (LER) to treat lower eyelid involutional entropion. This study aimed to examine the recurrence rate and complications of the percutaneous and transconjunctival approaches. This was a retrospective study of procedures conducted from January 2015 to June 2020. The LER shortening was performed for lower eyelid involutional entropion on 103 patients (116 eyelids). From January 2015 to December 2018, LER shortening using the percutaneous approach was implemented; from January 2019 to June 2020, the transconjunctival approach was used to shorten the LER. All patient charts and photographs were retrospectively reviewed. Recurrence occurred in 4 patients (4.3%) in the percutaneous approach. No recurrence was observed in any patient in the transconjunctival approach. Temporary ectropion occurred in 6 patients (7.6%) when the percutaneous approach was used; all cases healed within 3 months after surgery. The study did not reveal any statistically significant difference in recurrence rates between the percutaneous and transconjunctival approaches. We achieved results equal to or better than percutaneous LER shortening by combining transconjunctival LER shortening with horizontal laxity shortening, such as lateral tarsal strip, pentagonal resection, and orbicularis oculi muscle resection. However, it is necessary to be careful about temporary ectropion after surgery when percutaneous LER shortening alone is performed for lower eyelid entropion.
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Affiliation(s)
- Kenichi Kokubo
- Department of Plastic Surgery, Fujisawa Shounandai Hospital, 2345 Takakura, Fujisawa-shi, Kanagawa 251-0802, Japan; Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0004, Japan.
| | - Nobutada Katori
- Department of Ocular Plastic & Orbital Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu-shi, Shizuoka 430-8558, Japan
| | - Kengo Hayashi
- Yokohama Sakuragicho Eye Clinic, 1-200 Hinodecho, Naka-ku, Yokohama-shi, Kanagawa 231-0006, Japan
| | - Akiko Fujii
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0004, Japan
| | - Tomoyuki Koike
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama-shi, Kanagawa 232-0024, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0004, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0004, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0004, Japan
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Mateos-Olivares M, Belani-Raju M, Sánchez-Tocino H, Ye-Zhu C, Sales-Sanz M, Bragante A, Fernandes de Sousa Meneghim RL, Schellini SA, Galindo Ferreiro A. Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience. Eur J Ophthalmol 2023:11206721231155665. [PMID: 36760116 DOI: 10.1177/11206721231155665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
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.
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Affiliation(s)
- Milagros Mateos-Olivares
- Ophthalmology Department, 16238Hospital Clínico Universitario de Valladolid (HCUV), Valladolid, Spain
| | - Minal Belani-Raju
- Ophthalmology Department, 16918Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Cristina Ye-Zhu
- Ophthalmology Department, 16507Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marco Sales-Sanz
- Ophthalmology Department, 16507Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,IMO Grupo Miranza, Madrid, Spain
| | - André Bragante
- Ophthalmology Department of Medical School, 67785State University of Sao Paulo (UNESP), São Paulo, Brazil
| | | | - Silvana A Schellini
- Ophthalmology Department of Medical School, 67785State University of Sao Paulo (UNESP), São Paulo, Brazil
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Clauss KD, Ohana O, Patel A, Wester ST, Lee B, Alabiad CR, Tse BC, Lee WW. Lateral Tarsal Strip Complications With and Without Conjunctiva Stripping. Ophthalmic Plast Reconstr Surg 2022; 38:458-461. [PMID: 35323138 PMCID: PMC9464654 DOI: 10.1097/iop.0000000000002159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Kevin D. Clauss
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Oded Ohana
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Annika Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Sara T. Wester
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Bradford Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Chrisfouad R. Alabiad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Brian C. Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Wendy W. Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
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Natarajan R, Bhende M, Giridhar D. Bilateral corneal ulcers and endophthalmitis after eyelid surgery due to multi-drug resistant mixed infections. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Assessment of the Safety and Efficacy of Prolapsed Orbital Fat Resection During Involutional Entropion Repair. Ophthalmic Plast Reconstr Surg 2019; 36:34-37. [PMID: 31567912 DOI: 10.1097/iop.0000000000001452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the recurrence rate of involutional entropion in patients treated with a combined approach including a modified Bick procedure, excision of preseptal orbicularis muscle, and conservative resection of prolapsed orbital fat. METHODS A retrospective chart review of patients undergoing repair of involutional entropion with the combined procedure including orbital fat resection and a second group with standard entropion repair without orbital fat resection was performed. Only patients with follow-up greater than 6 months were included in the study. RESULTS Seventy eyelids of 54 patients met all inclusion criteria for the combined procedure group over a 9-year period from 2008 to 2016. Average follow-up was 46.9 months. There was a documented recurrence of entropion in 1 eyelid during the follow-up period (1.4%). The remaining 69 cases had successful subjective and objective results without need for any additional procedures. In the group undergoing entropion repair without fat resection, 22 eyelids of 19 patients had the required follow-up period with a recurrence rate of 4.5% (p > 0.05). CONCLUSIONS The authors demonstrate good surgical success with a combined approach of a modified Bick procedure, preseptal orbicularis excision, and conservative orbital fat resection. Conservative fat resection during entropion repair was found to be safe, and the combined procedure was found to be effective with a rate of recurrent entropion of 1.4% on extended follow-up.The authors propose that orbital fat prolapse contributes to the mechanics of involutional entropion and that conservative orbital fat resection during surgical repair of entropion can be done safely, resulting in low recurrence rates.
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Han J, Lee SH, Shin HJ. Mini-incisional entropion repair for correcting involutional entropion: Full description and surgical outcome. Medicine (Baltimore) 2019; 98:e16731. [PMID: 31415368 PMCID: PMC6831266 DOI: 10.1097/md.0000000000016731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to report the surgical outcome of mini-incisional correction method to treat involutional entropion.This is a retrospective interventional case series of 46 eyelids in 31 patients with involutional entropion and significant ocular irritation. In this technique, after turning the lower eyelid inside out, threads are introduced into it through the conjunctiva close to the inferior fornix. The lower lid retractor and tarsus are then connected using threads. These threads are applied at 3 locations of the lower eyelid and tightening them results in the eyelid being everted and the correction of entropion. Surgical success was defined as no contact between the eyelashes and the globe during forced closure of the eyelids. Surgical failure was defined as persistence of the eyelashes remaining in contact with the globe or cosmetic dissatisfaction.During the mean follow-up period of 22.1 months (range, 12-34 months), 43 of the eyelids (93.5%) were successfully corrected. Two patients (3 eyelids) experienced recurrence: 1 had involutional entropion combined with a cicatricial component, and the other had blepharospasm and apraxia of eyelid opening related to Parkinsonism. No postoperative complications such as overcorrection, suture-knot exposure, or ocular irritation were observed.Our mini-incisional entropion repair is based on reinforcement of the lower eyelid retractors using transconjunctival buried sutures. This technique is a quick, simple, and predictive for involutional entropion repair, and has a high success rate.
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Affiliation(s)
- Jisang Han
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Shin-Hyo Lee
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine
| | - Hyun Jin Shin
- Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Comparison of four Combined Procedures for Correction of Involutional Lower Eyelid Entropion. J Craniofac Surg 2019; 30:1239-1244. [DOI: 10.1097/scs.0000000000005466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Cheung JJC, Wong CKH, Cheung LTY. Combined pentagonal resection and inferior retractor plication in involutional entropion. BMC Ophthalmol 2018; 18:329. [PMID: 30567578 PMCID: PMC6299990 DOI: 10.1186/s12886-018-0986-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/29/2018] [Indexed: 12/02/2022] Open
Abstract
Background To describe the effectiveness of combined pentagonal resection and inferior retractor plication (PR + IRP) based on the Hill’s procedure for the treatment of primary involutional lower eyelid entropion in the Chinese population. Methods This is a retrospective review of 52 eyelids of 46 patients who underwent PR + IRP for treatment of involutional entropion between May 2009 and May 2017. Patient demographics, presence of pre-operative laxity, post-operative outcome and presence of complications were all recorded from electronic patient records. Results A total of 52 eyelids of 46 patients received PR + IRP. None had recurrence of entropion, 1 (2.1%) had residual entropion, 2 eyelids (4.4%) had lower eyelid notching, 1 eyelid (2.2%) had infection and 1 eyelid (2.2%) had overcorrection. The overall success rate was 90.4%. Conclusion Combined PR + IRP is an effective surgical procedure for primary involutional entropion with low recurrence rate. However, it may carry risk of eyelid notching post-operatively.
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Affiliation(s)
- Janice J C Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China. .,Department of Ophthalmology, Grantham Hospital, Hong Kong, Hong Kong, Special Administrative Region of China.
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Leanne T Y Cheung
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
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Abstract
The Lazy-T procedure is used to correct moderate-to-severe punctal ectropion in the lower eyelid. It includes full-thickness wedge resection of the medial lower eyelid and horizontal tarso-conjunctival diamond excision inferior to the lower punctum. However, the skin wound vertical to the relaxed skin tension lines is often conspicuous and horizontal excision of a part of the tarsus may impair function of the meibomian gland. In this study, the authors developed a modified Lazy-T procedure, which includes subciliary incision, pentagonal tarso-conjunctival resection, and medial spindle excision for submerging the vertical wound after suturing the pentagonal tarso-conjunctival resection under the skin flap and minimizing damage to the tarsus. The modified Lazy-T procedure was applied in 4 eyelids of 3 patients and achieved good anatomical results with cosmetically acceptable postoperative appearances and no remarkable complication.
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Lin P, Kitaguchi Y, Mupas-Uy J, Sabundayo MS, Takahashi Y, Kakizaki H. Involutional lower eyelid entropion: causative factors and therapeutic management. Int Ophthalmol 2018; 39:1895-1907. [DOI: 10.1007/s10792-018-1004-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/11/2018] [Indexed: 11/24/2022]
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Athavale DD, O'donnell BA. Lower eyelid entropion repair with retractor mobilization and insertion onto the anterior surface of the tarsal plate. Orbit 2018; 37:121-124. [PMID: 29040033 DOI: 10.1080/01676830.2017.1383450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To evaluate a modified surgical technique for the correction of lower eyelid involutional entropion in terms of recurrence rate and relief of symptoms. METHOD A prospective series of 67 consecutive eyelids in 55 patients who underwent lower eyelid entropion repair using a modified surgical approach not previously published in the literature to the authors' knowledge. The surgical technique, via a skin crease incision, involves disinsertion of the lower eyelid retractors from the tarsus and conjunctiva and suturing the retractors onto the anterior surface of the tarsal plate. Standard excision of redundant lower lid skin and orbicularis muscle was also performed as well as lateral canthal tendon repair. All procedures were performed by a single surgeon (B. A. O'donnell). This study adhered to the principles of the Declaration of Helsinki. RESULTS There were 67 eyelids with a minimum of 12 months follow-up: of these only 1 patient (1%) required revision surgery (average follow-up 24 months). Four other eyelids had persistent or recurrent irritation (6%) not suggestive of, or secondary to, recurrence. Seven eyelids (10%) had undergone previous operative repair with no further recurrence following their most recent surgery. CONCLUSION Disinsertion and reattachment of the retractors to the anterior tarsal plate in lower eyelid entropion repair is an effective surgical technique to improve lower eyelid stability. Although minimum follow-up is 12 months and average follow-up 24 months, longer follow-up would further evaluate this technique.
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Affiliation(s)
| | - Brett A O'donnell
- a Department of Ophthalmology , Royal North Shore Hospital , Sydney , NSW , Australia
- b Department of Ophthalmology , St. Vincent's Hospital , Sydney , NSW , Australia
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Dunbar KE, Cox C, Heher KL, Kapadia MK. Lateral tarsal strip plus skin-muscle flap excision in the treatment of lower eyelid involutional entropion. Orbit 2017; 36:375-381. [PMID: 28837414 DOI: 10.1080/01676830.2017.1337190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/28/2017] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Kristen E Dunbar
- a New England Eye Center, Tufts Medical Center , Boston , Massachusetts , USA
| | - Catherine Cox
- a New England Eye Center, Tufts Medical Center , Boston , Massachusetts , USA
| | - Katrinka L Heher
- a New England Eye Center, Tufts Medical Center , Boston , Massachusetts , USA
| | - Mitesh K Kapadia
- a New England Eye Center, Tufts Medical Center , Boston , Massachusetts , USA
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López-García JS, García-Lozano I, Giménez-Vallejo C, Jiménez B, Sánchez Á, de Juan IE. Modified lateral tarsal strip for involutional entropion and ectropion surgery. Graefes Arch Clin Exp Ophthalmol 2016; 255:619-625. [DOI: 10.1007/s00417-016-3536-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 09/26/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022] Open
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Chu YC, Yang JW, Tsai YJ, Wu SY, Liao YL, Chu HY. Correction of involutional entropion with retractor redirection. Orbit 2016; 35:207-211. [PMID: 27322152 DOI: 10.1080/01676830.2016.1176215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The study aims to report the surgical outcome of a retractor redirection procedure for involutional entropion repair for Asians. The study included all cases diagnosed with involutional entropion and significant ocular irritation who presented from 2008 to 2012. Sixty-seven eyelids in 54 patients were included in this study. All cases were operated on by one surgeon and had a minimum of 12-months follow-up. Success was defined as cases showing no recurrence of entropion with forceful eyelid squeezing postoperatively. A retrospective chart review was performed to assess the success rate, recurrences and complications of the procedure. During a mean follow-up period of 26.2 months (range, 12-53 months), 5 patients died during the study period. Two eyelids (3%) of one patient had a recurrence at 34 months postoperatively. One eyelid (1.5%) with a significant horizontal laxity developed postoperative ectropion and required a secondary horizontal shortening procedure. No other postoperative complications or dissatisfaction were reported. The retractor redirection procedure aims to repair the retractors and prevent orbicularis muscle overriding via inserting the retractors to the anterior lamellae. It yields a long-term success rate of 95.5% and is an effective technique for correcting involutional entropion.
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Affiliation(s)
- Yen-Chang Chu
- a Department of Ophthalmology, Chang Gung Memorial Hospital , Chang Gung University, College of Medicine , Taoyuan , Taiwan
| | - Ju-Wen Yang
- b Department of Ophthalmology, Chang Gung Memorial Hospital , Chang Gung University, College of Medicine , Keelung , Taiwan
| | - Yueh-Ju Tsai
- a Department of Ophthalmology, Chang Gung Memorial Hospital , Chang Gung University, College of Medicine , Taoyuan , Taiwan
| | - Shu-Ya Wu
- a Department of Ophthalmology, Chang Gung Memorial Hospital , Chang Gung University, College of Medicine , Taoyuan , Taiwan
| | - Yi-Lin Liao
- a Department of Ophthalmology, Chang Gung Memorial Hospital , Chang Gung University, College of Medicine , Taoyuan , Taiwan
| | - Hsueh-Yen Chu
- a Department of Ophthalmology, Chang Gung Memorial Hospital , Chang Gung University, College of Medicine , Taoyuan , Taiwan
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Ishida Y, Takahashi Y, Kakizaki H. Posterior layer advancement of lower eyelid retractors with transcanthal canthopexy for involutional lower eyelid entropion. Eye (Lond) 2016; 30:1469-1474. [PMID: 27419836 DOI: 10.1038/eye.2016.150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/13/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeThe purpose of this study was to examine the surgical outcome of posterior layer advancement of the lower eyelid retractors (LER) with transcanthal canthopexy for involutional lower eyelid entropion.Patients and methodsFifty-one eyelids of 41 patients with involutional entropion and vertical and horizontal laxities that underwent posterior layer advancement of the LER with transcanthal canthopexy were retrospectively reviewed. As a control, we also reviewed previously reported data from 47 entropic eyelids of 37 patients with vertical and horizontal laxities that were successfully corrected using LER advancement and a lateral tarsal strip procedure. Surgical success was defined as the normal eyelid position without contact of any cilia to the globe at the last follow-up examination.ResultsAll eyelids in the present study group were judged as successfully treated without recurrence after 13.9±9.2 months of follow up (mean±SD). The surgical time in the present study group (22.4±5.5 min) was significantly shorter than that in the control group (mean 31.3±4.9 min; P<0.001; Student's t-test). None of the patients showed lateral canthal deformity after surgery.ConclusionsPosterior layer advancement of the LER with transcanthal canthopexy provided complete surgical success with shorter surgical time without the risk of lateral canthal deformity. Posterior layer advancement of the LER with transcanthal canthopexy can be an option for correction of involutional lower eyelid entropion in patients with both vertical and horizontal laxities.
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Affiliation(s)
- Y Ishida
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan
| | - Y Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan
| | - H Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan
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Lokdarshi G, Pushker N, Bajaj MS, Meel R. Entropion: understanding the management. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1112738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Orbicularis oculi muscle transposition for repairing involutional lower eyelid entropion. Graefes Arch Clin Exp Ophthalmol 2014; 252:1315-8. [DOI: 10.1007/s00417-014-2694-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/29/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022] Open
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24
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Rabinovich A, Allard FD, Freitag SK. Lower eyelid involutional entropion repair with lateral tarsal strip and infraciliary rotation sutures: surgical technique and outcomes. Orbit 2014; 33:184-8. [PMID: 24660998 DOI: 10.3109/01676830.2014.894540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Tsang S, Yau GSK, Lee JWY, Chu ATK, Yuen CYF. Surgical outcome of involutional lower eyelid entropion correction using transcutaneous everting sutures in Chinese patients. Int Ophthalmol 2013; 34:865-8. [DOI: 10.1007/s10792-013-9893-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/18/2013] [Indexed: 12/01/2022]
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Abstract
PURPOSE To present a modified transconjunctival approach for involutional entropion repair. METHODS This study is a retrospective consecutive single surgeon case series using a transconjunctival approach for involutional lower lid entropion (ILLE) repair. RESULTS Eleven eyes were operated for involution entropion with 9 cases of complete resolution. Two patients required further Jones' retractor plication. CONCLUSION Transconjunctival involutional lower lid entropion repair is a time-efficient, safe, and efficacious technique. The scar free technique described leads to full restoration of lower lid anatomy. In contrast to other reports we found a relatively low rate of recurrence on follow-up.
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Affiliation(s)
- Andreas J Kreis
- Victoria Eye Unit, Hereford County Hospital , Hereford , United Kingdom
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27
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Why does the corrective procedure of the ectropion work for repairing the entropion? J Craniofac Surg 2012; 23:1133-6. [PMID: 22777459 DOI: 10.1097/scs.0b013e31824e6b4e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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.
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Then SY, Salam A, Kakizaki H, Malhotra R. A lateral approach to lower eyelid entropion repair. Ophthalmic Surg Lasers Imaging Retina 2011; 42:519-22. [PMID: 21902165 DOI: 10.3928/15428877-20110901-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 07/22/2011] [Indexed: 11/20/2022]
Abstract
The authors describe a simple technique that highlights the use of the sagittal anatomy of the lower eyelid to aid identification of the retractors during involutional entropion repair. This anatomy is exposed following lateral canthotomy and inferior cantholysis. The orbital septum is seen to enclose the fat pad and fuse with the retractors above it prior to insertion into the tarsus. The septum, orbicularis, and skin are incised from the lateral approach, allowing exposure of the retractors for tarsal reattachment, and the procedure is completed with a lateral tarsal strip. Forty-eight procedures in 42 patients with involutional entropion were performed using this technique and 90% and 89% of primary and recurrent entropion, respectively, were successfully repaired. Mean operating time was 30 minutes. The lateral approach to a standard procedure for entropion repair can reduce operating time and technical difficulty.
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Affiliation(s)
- Siew-Yin Then
- Queen Victoria Hospital, Corneoplastic Unit, East Grinstead, United Kingdom
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LEIBOVITCH IGAL. Lateral Wedge Resection: A Simple Technique for Repairing Involutional Lower Eyelid Entropion. Dermatol Surg 2010; 36:1412-8. [DOI: 10.1111/j.1524-4725.2010.01650.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Entropion is an inward folding malposition of the eyelid margin. As a result of persistent entropion and trichiasis severe complications of the conjunctiva and the cornea can occur, which can lead to loss of visual acuity. Conservative forms of therapy mostly provide only a temporary solution and are generally used in preoperative care or if surgical intervention is unfeasible. The main therapeutic means is surgery. Normally congenital entropion recedes throughout the first 12 months of life, so that surgery is not needed immediately. Spastic inflammatory entropion disappears with successful treatment of the inflammation. Senile entropion is caused by three different pathological mechanisms: loss of lid laxity, loss of tension of lower lid retractors and alterations to the musculus orbicularis. These can be corrected with the procedures developed by Wies and also by Quickert and Jones. The surgeon should be careful to avoid an overcorrection with iatrogenic ectropion. Finally, cicatricial entropion can occur as a consequence of persistent inflammation or injuries. In this case free mucosa grafts may be necessary.
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Affiliation(s)
- K Wozniak
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum der TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Lee S, Goldberg RA, Ben Simon GJ. Postoperative complications in ophthalmic plastic and reconstructive surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.6.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bibliography. Current world literature. Pediatrics and strabismus. Curr Opin Ophthalmol 2007; 18:434-6. [PMID: 17700239 DOI: 10.1097/icu.0b013e3282f0361d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bernardino CR. Alternative etiology and surgical correction of acquired lower-eyelid entropion. Ann Plast Surg 2007; 59:229. [PMID: 17667423 DOI: 10.1097/sap.0b013e31806ab3c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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