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

Abstract

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.

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

“…7,9,17,19,[23][24][25][26] Another type of technique to correct LEIE is blind retractor plication using everting sutures of the lower eyelid (Quickert or Wies sutures). [32][33][34] Consistent with other studies, the success rates for the ARR and PRR approaches were similar. 7,15,17,22,[24][25][26] However, PRR is faster and easier to perform because retractors can be found just behind the conjunctiva, no skin incisions are required, the orbicularis muscle and the possibility of bleeding are avoided and there is no visible scar.…”

Outcomes of combined procedures compared to various single techniques for involutional entropion

“…An ES technique is an affordable and straightforward method of entropion correction which can be performed rapidly, often upon the patient's first visit to the hospital. [ 24 25 26 ] The sutures help to plicate the attenuated inferior eyelid retractors and transfer their pull to the anterior surface of the lower tarsus. They also create a horizontal barrier to prevent the preseptal orbicularis oculi muscle migration.…”

“…Sen and Yalcinsoy reported a success rate of 96.4% over a mean follow-up period of 27 months using an incision-based modified ES technique, while Han et al reported an overall success rate of 93.5% after mini-incisional entropion repair involving sutures. [ 26 , 30 ] A study by Rougraff et al demonstrated a success rate of 78% using fornix sutures and LTS with a minimum of 18 months’ follow-up. [ 31 ]…”

Comparison of Outcomes for Triangular Tarsectomy and Limited Orbicularis Myectomy with Lower Lid Retractor Plication Versus Everting Sutures for Involutional Entropion.

“…18 An ES technique is an affordable and simple method of entropion correction which can be performed rapidly, often upon the patient's first visit to hospital. [22][23][24] The sutures help to plicate the attenuated inferior eyelid retractors and transfer their pull to the anterior surface of the lower tarsus; in addition, they also create a horizontal barrier to prevent the migration of the preseptal orbicularis oculi muscle. The successful outcome of this procedure depends on forming a fibrotic scar along the suture tracks.…”

“…reported an overall success rate of 93.5% after mini-incisional entropion repair involving sutures. 24,30 A study by Rougraff et al demonstrated a success rate of 78% using fornix sutures and LTS with a minimum of 18 months follow-up. 31 Unfortunately, the ES technique alone offers only temporary correction of the involutional entropion.…”