Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion

Moon Yoon Jae; A Kim Sun; Heon Roh Joo

doi:10.3341/jkos.2008.49.12.1877

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Jae, Sun, and Joo: Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion

Original Article

J Korean Ophthalmol Soc 2008;49(12):1877-1887.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.12.1877

Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion

Moon Yoon Jae, M.D., A Kim Sun, M.D., Heon Roh Joo, M.D., Ph.D.

Sungmo Eye Hospital, Pusan, Korea

Address reprint requests to Joo Heon Roh, M.D., Ph.D. Sungmo Eye Hospital #1078-7, Woo2-dong, Haeundae-gu, Pusan 608-838, Korea Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: rhoahn@yahoo.co.kr

Received 4 December 2008 Accepted 4 July 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion.

Methods

This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb).

Results

The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively.

Conclusions

The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.

Keywords: Horizontal lid laxity, Involutional entropion, Lateral tarsal strip procedure, Lower retractor reinsertion procedure, Quickert suture

References

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Figure 1.

Distraction test. The patient shows horizontal lid laxity.

Figure 2.

Lateral tarsal strip operation and Quickert suture. (A) Lateral tarsal strip operation and Quickert suture were done to the patient who had horizontal lid laxity. (B) End of the operation of lateral tarsal strip operation and Quickert suture.

Figure 3.

Lower lid retractor reinsertion operation. Disinserted lower lid retractor was found and was going to be reinserted to the lower tarsal plate margin.

Figure 4.

Orbicularis muscle and skin flap excision. (A) After lower lid retractor reinsertion. (B) Orbicularis muscle and skin redundancy was measured by pulling the lower lid and marked by gentian violet. (C) The end of the orbicularis muscle and skin flap excision. (D) Preoperative picture. (E) Postoperative picture (2 months after surgery).

Figure 5.

(A)(B) The patient shows involutional entropion with horizontal lid laxity. (C) Preoperative picture. Lateral tarsal shortening with Quickert suture was performed on the right eye. (D) Postoperative picture (2 months after surgery). The entropion was corrected on the right eye.

Figure 6.

(A)(B) The patient shows involutional entropion without horizontal lid laxity. (C). Preoperative picture. Reinsertion of lower lid retractors was performed on the right eye. (D) Postoperative picture (2 months after surgery). The entropion in the right eye was corrected.

Table 1.

Demographics of patient populations according to the horizontal lid laxity

	Patient/Eyes	Percentage	Average age
Eyes with horizontal lid laxity (Group I)	46/62	59.6%	72.9±7.3
Eyes without horizontal lid laxity (Group II)	33/42	40.4%	70.4±7.9
Total	79/104	100%	71.9±7.6
			Student t-test
			P=0.153

Table 2.

Demographics of patient population according to the operative method

	Patients/Eyes 12/17	Sex (M/F) Age (4/8) 69.8±6.2	Follow-up (average, months) 9.7±7.6
Group Ia	12/17	(4/8)69.8±6.2	(4/8)69.8±6.2
Lateral canthal shortening
Group Ib	34/45	(13/21) 73.9±7.8	10.6±12.0
Lateral canthal shortening & Quickert sutures
Group IIa	12/13	(5/7) 72.7±9.7	16.8±14.8
Reinsertion of lower lid retractors
Group IIb	21/29	(6/15) 69.7±6.5	9.6±8.0
Reinsertion of lower lid retractors &
Excision of orbicularis muscle-skin flap
Total	79/104	(28/51) 71.9±7.6	11.0±10.9
		Chi-square ANOVA	ANOVA
		(3d.f.)=0.78(3d.f.)=2.38	(3d.f.)=1.53
		P=0.86 P=0.74	P=0.21

Table 3.

Outcomes according to the operative methods

	Patients/Eyes	Recurrence	Overcorrection
Group Ia	12/17	2 eyes (11.7%)	0 eye (0%)
Lateral canthal shortening
Group Ib	34/45	0 eye (0%)	0 eye (0%)
Lateral canthal shortening & Quickert sutures
		Fisher’s Exact test
		P=0.072
Group IIa	12/13	2 eyes (15.4%)	2 eyes (15.4%)
Reinsertion of lower lid retractors
Group IIb	21/29	2 eyes (6.9%)	0 eye (0%)
Reinsertion of lower lid retractors
& Excision of orbicularis muscle-skin flap
		Fisher’s Exact test	Fisher’s Exact test
		P=0.576	P=0.091
Total	79/104	6 eyes (5.8%)	2 eyes (1.9%)

Table 4.

Comparison of published techniques

Author	Reference No.	Technique	No. of Operations	Follow-up (mo)	Recurrence rate	Complications
This study		Horizontal lid laxity (-)	62	10.2	3.2%	None
		LTS∗±Fornix suture
		Horizontal lid laxity (+)	42	13.2	9.5%	Ectropion (2)
		Retractor reinsertion
		±Orbicularis excision
Baek	35	Retractor reinsertion	27	7.8	3.7%	Conjuctivochalasis
Kim	36	Retractor reinsertion	11	13.4	0%	ectropion
		Orbicularis excision
		LTS procedure
Ahn	37	Without lid laxity	14	19.3	7.1%	ectropion
		Retractor reinsertion
		Orbicularis excision
		With lid laxity	16	17.4	0%	conjunctivochalasis
		Retractor reinsertion
		Orbicularis excision
		LTS procedure
Jung	38	Retractor reinsertion	14	6~26	0%	Subcutaneous
		Orbicularis excision				hematoma
Iliff	39	Fornix suture	22	>12	9%	None
Dresner	18	Retractor reinsertion	23	9~18	0%	Infection
		LTS procedure
Carroll	19	Retractor reinsertion	127	33	0%	Ectropion
		Orbicularis excision				Granuloma
		LTS procedure				Dehisence

^∗ LTS=Lateral Tarsal Strip.

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