Randomized Controlled Trial Comparing Everting Sutures with a Lateral Tarsal Strip for Involutional Lower Eyelid Entropion

Abstract

Introduction To compare the anatomical and functional outcome and changes in the quality of life (QoL) over time of the lateral tarsal strip (LTS) versus the Quickert everting sutures (ES) for the repair of primary involutional lower eyelid entropion. Methods Forty-five patients (54 eyes) with primary involutional lower eyelid entropion were recruited in a prospective randomized clinical trial over 3-year period. Twenty-six eyes were randomized to the LTS technique and 28 to the ES procedure. Primary outcome was the anatomical correction of the eyelid at the final assessment in 1 year. Secondary outcomes were function and symptoms assessment with a QoL questionnaire at 6 months. Fisher’s exact test was used for the statistical analysis of success rate and gender study and Mann–Whitney U test and logistic regression analysis were used for age study. The Wilcoxon and Mann–Whitney U tests were used for the analysis of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25). Results At the 6-month follow-up, 25 eyes (96.2%) of the LTS group and 20 (71.4%) of the ES group had favorable outcome ( P = 0.025). There were one and eight eyes, respectively, with early recurrence. At the final 12-month evaluation, 23 eyes (88.5%) in the LTS group and 16 eyes (57.1%) in the ES group were successful. Three (11.5%) and 12 (42.9%) eyes respectively showed postoperative recurrence. There was a statistically significant difference between the two groups ( P = 0.015) for the primary outcome, whereas age and gender did not influence success. The NEI VFQ-25 showed statistically significant subjective improvement from baseline in most categories of the QoL. No significant difference between the two procedures was detected at 6 months. Conclusion This study suggests that the LTS procedure has a superior surgical success rate and reduction of symptoms compared with the ES for the repair of involutional lower eyelid entropion. Both procedures showed similar improvement of the postoperative QoL. Trial registration International Clinical Trials Registry Platform identifier: ACTRN12616000620426.

Comments on: Randomized Controlled Trial Comparing Everting Sutures with a Lateral Tarsal Strip for Involutional Lower Eyelid Entropion

“…We read with great interest the recent article by Nakos et al that showed the lateral tarsal strip (LTS) to have superior surgical success rates and reduction of symptoms than Quickert everting sutures (ES) in the repair of primary involutional lower eyelid entropion after one year [1]. We wish to complement their findings with those of our own Yorkshire Entropion Study (not previously published)-a randomised controlled trial with long-term (12-year) follow-up in which we attempt to compare two techniques for the surgical correction of involutional entropion.…”

Response to Comments on Randomized Controlled Trial Comparing Everting Sutures with a Lateral Tarsal Strip for Involutional Lower Eyelid Entropion

“…We thank Dr Jamison et al for their constructive comments on our recent publication [1]. The fact that this was only the second randomized controlled clinical trial (RCT) on involutional lower lid entropion indicates that there is a great need for scientific evidence in the field of oculoplastic surgery.…”

Comparison of everting sutures and the lateral tarsal strip with or without everting sutures for involutional lower eyelid entropion: A meta-analysis

“…Disagreements in the literature selection were resolved by discussion between the two investigators. Finally, two articles were selected [8,9] (Fig 1).…”

“…In the Nakos trial [8], one patient in the LTS group developed an abscess in the lateral canthal area at 12 months. In the Scheepers trial [9], a suture-related granuloma was observed with two patients in the ES group and no case of ectropion was observed.…”

“…In the Scheepers trial [9], a suture-related granuloma was observed with two patients in the ES group and no case of ectropion was observed. In the Nakos [8] and Scheepers trials [9], the risk ratios for complications between the ES group and LTS +/-ES group were 0.31 (95% CI: 0.01 to 7.30, P = 0.47) and 4.50 (95% CI: 0.23 to 89.62, P = 0.32), respectively. .…”