Anterior lamellar recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos

Abstract

Purpose To assess the results of anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure in patients with upper eyelid cicatricial entropion without lagophthalmos. Methods In a prospective interventional case series, 52 eyelids (32 patients) were included (April 2009-December 2010. Excluded were patients with previous eyelid surgeries, lagophthalmos, and o12 months of follow-up. Using a microscope, after recessing anterior lamella 3-4 mm above the eyelid margin, it was fixed with 4-5 interrupted 6-0 vicryl sutures. Excess anterior lamella was then excised (blepharoplasty), supratarsal fixation sutures (6-0 vicryl) were put and the skin was closed with 6-0 nylon sutures. Success and failure defined based upon eyelash-globe touch on the last followup visit (at least 12 months), respectively. Results There were 21 females (65.6%) and 11 males (34.4%) with a mean age of 69.7 years (SD = 6.9) and mean follow-up of 21.06 months (SD = 8.26). Success was observed in 39 (75%) and failure in 13 (25%). Mean time of failure was 4.5 months (SD = 3). Although re-treatment with radio-frequency electrolysis (eight eyelids) and re-anterior lamellar recession (two eyelids) resulted in success in 12 eyelids with failure, two patients (three eyelids) declined further procedure. Except for thickened eyelid margin, no complications were observed. Conclusion Anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure is an effective and safe technique for the treatment of the upper eyelid cicatricial entropion without lagophthalmos.

<p>Anterior Lamellar Recession versus Posterior Lamellar Tarsal Rotation for Lower Lid Trachomatous Trichiasis: A Randomized Controlled Trial</p>

“…18 Additional potential advantage of these sutures is prevention of upward sliding of anterior lamella to its original position till firm adhesion between both lamellae form. 19 …”

“…18 Additional potential advantage of these sutures is prevention of upward sliding of anterior lamella to its original position till firm adhesion between both lamellae form. 19 The suboptimal surgical results among the PLTR group could be attributed for the following: first, a horizontal tarsal incision will leave a small distal segment of only 2mm to be rotated. This can hinder effective lid margin eversion.…”

The upper eyelid levator weakening procedure for the correction of severe cicatricial entropion caused by trachoma

“…The definitive treatment for trachoma-induced UCE is surgery. Surgeons have developed various surgical techniques to address UCE, including tarsotomy with margin rotation (6), posterior lamella lengthening using grafts (7), eyelash resection (8), and anterior lamella recession (9). But due to the special anatomical characteristics, the single surgery isn't suitable for Chinese…”

Response to comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision

“…We agree that the case with dermatochalasis in your report would perhaps benefit from a small concurrent blepharoplasty, and therefore, a skin-crease incision would provide further exposure. [ 3 4 ] A skin-crease reformation, if required, is not necessarily an indication for a skin-crease incision. This can easily be performed without a skin-crease incision in a “closed” manner by simply passing double-armed sutures from the aponeurosis through to the skin crease.…”