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The Versatile Lid Crease Approach to Upper Eyelid Margin Rotation.

Cruz AA, Akaishi PM, Al-Dufaileej M, Galindo-Ferreiro A - Middle East Afr J Ophthalmol (2015 Oct-Dec)

Bottom Line: We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion.Forty percent of the patients (24 lids) had more than 3 months of follow-up.Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil ; Oculoplastic Division, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia ; Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.

ABSTRACT
Lid margin rotational procedures have been used to correct cicatricial trachomatous entropion since the 19(th) century. There are two basic types of surgeries used for lid margin rotation. The first type is based on through-and-through approach combining tarsotomy and the use of sutures on the anterior lamella. The second type of surgery was suggested by Trabut, who proposed a tarsal advancement by posterior approach. We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion. After tarsal plate exposure, a tarsotomy through conjunctiva is performed as described by Trabut. Then, instead of using external sutures secured by bolsters, internal absorbable sutures can be used to simultaneously advance the distal tarsal fragment and exert strong tension on the marginal orbicularis muscle. Sixty lids of 40 patients underwent surgery with a lid crease incision. The follow-up ranged from 1 to 12 months (mean 3.0 months ± 2.71). Forty percent of the patients (24 lids) had more than 3 months of follow-up. Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea.

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Related in: MedlinePlus

Top: Aged patient with upper dermatochalasis and cicatricial entropion. Lashes are misdirected with a downward direction. Bottom: Postoperative appearance of the rotated margin
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Figure 2: Top: Aged patient with upper dermatochalasis and cicatricial entropion. Lashes are misdirected with a downward direction. Bottom: Postoperative appearance of the rotated margin

Mentions: There were no major complications such as lid necrosis or significant contour abnormality. Trichiasis was corrected in all but one lid, with two inward lashes touching the cornea medially despite adequate margin position. Patients are satisfied with the surgical outcome. Figure 2 presents a typical example. This patient had cicatricial entropion, trichiasis, and a loose pretarsal anterior lamella with no clear lid crease preoperatively [Figure 2]. Postoperatively the degree of margin and lash rotation and lid crease reformation is evident.


The Versatile Lid Crease Approach to Upper Eyelid Margin Rotation.

Cruz AA, Akaishi PM, Al-Dufaileej M, Galindo-Ferreiro A - Middle East Afr J Ophthalmol (2015 Oct-Dec)

Top: Aged patient with upper dermatochalasis and cicatricial entropion. Lashes are misdirected with a downward direction. Bottom: Postoperative appearance of the rotated margin
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660523&req=5

Figure 2: Top: Aged patient with upper dermatochalasis and cicatricial entropion. Lashes are misdirected with a downward direction. Bottom: Postoperative appearance of the rotated margin
Mentions: There were no major complications such as lid necrosis or significant contour abnormality. Trichiasis was corrected in all but one lid, with two inward lashes touching the cornea medially despite adequate margin position. Patients are satisfied with the surgical outcome. Figure 2 presents a typical example. This patient had cicatricial entropion, trichiasis, and a loose pretarsal anterior lamella with no clear lid crease preoperatively [Figure 2]. Postoperatively the degree of margin and lash rotation and lid crease reformation is evident.

Bottom Line: We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion.Forty percent of the patients (24 lids) had more than 3 months of follow-up.Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil ; Oculoplastic Division, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia ; Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.

ABSTRACT
Lid margin rotational procedures have been used to correct cicatricial trachomatous entropion since the 19(th) century. There are two basic types of surgeries used for lid margin rotation. The first type is based on through-and-through approach combining tarsotomy and the use of sutures on the anterior lamella. The second type of surgery was suggested by Trabut, who proposed a tarsal advancement by posterior approach. We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion. After tarsal plate exposure, a tarsotomy through conjunctiva is performed as described by Trabut. Then, instead of using external sutures secured by bolsters, internal absorbable sutures can be used to simultaneously advance the distal tarsal fragment and exert strong tension on the marginal orbicularis muscle. Sixty lids of 40 patients underwent surgery with a lid crease incision. The follow-up ranged from 1 to 12 months (mean 3.0 months ± 2.71). Forty percent of the patients (24 lids) had more than 3 months of follow-up. Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea.

Show MeSH
Related in: MedlinePlus