Document Detail


Outcomes of lower eyelid cicatricial entropion with grey-line split, retractor recession, lateral-horn lysis, and anterior lamella repositioning.
MedLine Citation:
PMID:  22410661     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To report indications and outcomes of a technique for the correction of lower eyelid cicatricial entropion using a lower eyelid gray-line split, inferior retractor recession, lateral-horn lysis, and anterior lamella repositioning.
PATIENTS AND METHODS: Retrospective, 5-year, single-center, consecutive case series of patients with lower eyelid cicatricial margin entropion undergoing the above procedure. Patients with significant inferior fornix contraction or symblepharon undergoing concurrent fornix reconstruction with buccal mucosal grafts at the same time as lamella repositioning were excluded. Outcomes were assessed based on the review of medical case notes and clinical photographs assessed independently. Success was defined by: 1) improvement in eyelid position and 2) improvement in lower eyelid retraction.
RESULTS: Twenty-one eyelids of 19 patients (mean age 57.7 ± 22.6 years, range 5-95 years, 8 men and 11 women) were included. The mean follow up was 27.4 ± 16.8 (range 3.2-59.6) months. The causes of cicatricial entropion were as follows: ocular cicatricial pemphigoid (6), Stevens-Johnson syndrome (3), previous eyelid reconstruction (2), socket scarring (2), thermal burn (1), chemical burn (3), postradiotherapy (1), and meibomian gland dysfunction (1). A second procedure was carried out in 38% (8/21) of eyelids within 1 year. Within 3 years, 10% (2/21) and 5% (1/21) of eyelids required a third and fourth procedure, respectively. The most common lower eyelid revision procedures included anterior lamellar repositioning. Other procedures required included buccal mucous membrane grafts, everting sutures, and lateral tarsorrhaphy. Three patients with loss of >50% inferior fornix depth were included. Two had previously undergone mucosal grafts and 2 required subsequent mucosal grafts. Overall, 90% (19/21) of eyelids eventually achieved improvement in lower eyelid position following repeat surgery, including mucosal grafts in 3 eyelids. Mid-pupil lower eyelid elevation was 1 mm in 6 of 19 (32%) patients and lower eyelid lateral retraction significantly improved in 9 of 19 (47%) patients.
CONCLUSION: Based on the principles of lamella repositioning and posterior middle lamella release with formal retractor recession through a gray-line incision, this technique is of value as a lash-preserving procedure in moderate-to-severe cicatricial lower eyelid entropion, particularly where tarsoconjuctival contraction or eyelid margin distortion exists.
Authors:
Raman Malhotra; Carmen Yau; Jonathan H Norris
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Ophthalmic plastic and reconstructive surgery     Volume:  28     ISSN:  1537-2677     ISO Abbreviation:  Ophthal Plast Reconstr Surg     Publication Date:    2012 Mar-Apr
Date Detail:
Created Date:  2012-03-13     Completed Date:  2012-06-01     Revised Date:  2013-05-08    
Medline Journal Info:
Nlm Unique ID:  8508431     Medline TA:  Ophthal Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  134-9     Citation Subset:  IM    
Affiliation:
Department of Corneo-Plastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom. raman.malhotra@qvh.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cicatrix, Hypertrophic / pathology,  surgery*
Entropion / pathology,  surgery*
Eyelids / pathology,  surgery*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Oculomotor Muscles / pathology,  surgery*
Ophthalmologic Surgical Procedures*
Retrospective Studies
Treatment Outcome

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