Short Term Outcome of Anterior Lamellar Reposition in Treating Trachomatous Trichiasis

Abstract

Purpose. To evaluate the outcome of anterior lamellar reposition (ALR) in treating trachomatous trichiasis. Methods. Patients with trachomatous trichiasis or entropion with short tarsus were treated by ALR between February 2009 and November 2013. This included splitting of the lid margin behind the aberrant lash line to separate the lid lamellae. The anterior lamella was recessed and fixated using 4/0 silk sutures. The extra lashes and their routes were excised. Sutures were removed by the 3rd week and patients completed 6 months of follow-up. Recurrence of ≤5 lashes was treated by electrolysis. Results. The study included 752 eyelids (445 patients; 58.4% females, 41.6% males), mean age 53.2 ± 6.9 y. 179 (25.1%) lids had entropion while 287 (64.5%) patients had corneal affection. By the third week, 2.66% lid had trichiasis while 30.8% had no rubbing lashes. By the 6th month, 14.9% of lids showed recurrence while 66.1% were completely cured (CI = 0.63–0.69) and 19% had partial success (CI = 0.16–0.21). Abnormal lid appearance persisted in 2.66% and 12.9% required another surgery. Conclusion. ALR is a good option for treating trachomatous trichiasis especially without cicatricial entropion. Excision of dysplastic lashes is thought to augment the surgical outcome.

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

“…Regarding postoperative cosmesis, marginal thickening with abnormal appearance was noticed in all patients underwent ALR during the early postoperative period; however, this tends to soften with reversion to normal skin color within few weeks. Similarly, Ahmed and Abdelbaky 17 showed that most separated lid margins reverted to their normal color with upward remigration of anterior lamella within 3 months. The authors believe that preoperative counseling regarding possible poor cosmesis in the early postoperative period following ALR is important to reduce postoperative patient's anxiety.…”

“…16 In addition, the lid margin incision can be performed posterior to the more posterior aberrant eyelashes. 17 Anterior lamellar laxity with dermatochalasis was found in 4 patients with PTT who underwent ALR without repositioning sutures early in the study. However, the use of mattress sutures between lower lid retractors and anterior lamella has eliminated this complication in subsequent cases given the resultant anterior lamellar tightening.…”

Upper eyelid levator-recession and anterior lamella repositioning through the grey-line: Avoiding a skin-crease incision

“…combined the original procedure with terminal tarsal rotation. [ 9 ] As previously discussed, other authors have reported lid crease incision and lifting the anterior lamella off the posterior with or without a GLS[ 4 5 6 ] the obvious advantage being avoidance of surgery to the conjunctiva and hence improve safety in conditions such as OCP. [ 2 ]…”

“…Anterior lamellar repositioning (ALR) is a well-known, simple, and widely popular method for treating both upper and lower eyelid cicatricial margin entropion. [ 1 2 3 4 5 6 ] Welsh[ 1 ] described ALR with grey-line split (GLS) and suture repositioning for correcting cicatricial entropion in 1969. Some other published techniques have added a lid crease incision with GLS to recess the levator.…”

“…[ 2 3 7 ] Studies that describe GLS with the recession of the anterior lamellar and no lid crease incision do not describe concurrent levator recession (LR). [ 5 6 8 ] We report results of a procedure of ALR and LR through a single GLS for upper eyelid cicatricial changes [Fig. 1a and b ].…”