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Ru-ik Chee, Gary J Lelli, Benjamin M Levine, Lorraine Cassidy; A Retrospective Study Comparing Lateral Tarsal Strip with Everting Sutures to Two Other Surgical Methods for Lower Lid Involutional Entropion Repair. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4745. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The Lateral Tarsal Strip with Everting Sutures (LTS-ES) procedure has been described as a simple effective surgery for involutional entropion. We performed a retrospective, observational clinical study to evaluate the outcomes of LTS-ES and two other surgical methods in the management of lower lid involutional entropion.
We reviewed all surgeries performed for lower lid involutional entropion at the Royal Victoria Eye and Ear Hospital, Ireland, from January 2004 through December 2009. Patients were excluded if they had 1) less than 12 months of follow-up; 2) prior lid surgery, enucleation or trauma; 3) facial nerve palsy; 4) isolated use of everting sutures; 5) other causes of entropion such as cicatricial or congenital. Outcomes included any suboptimal result (recurrence of entropion, overcorrected ectropion, wound dehiscence), and need for re-operations. Student’s t, Chi-square, and Fischer’s exact tests were used in statistical analysis.
A total of 189 eyes from 164 patients were included. The most common procedure performed was LTS+ES (118 eyes, 62.4%), followed by Wies (43 eyes, 22.8%) and Wies with lateral full thickness wedge resection (Wies-R) (28 eyes, 23.7%). Mean age (77.2 vs. 80.2 years, p=0.1039), gender (59.3% vs. 46.5% males, p=0.1173), and follow up duration (16.3 vs. 19.9 months, p=0.944) were not significantly different between LTS-ES and non-LTS-ES groups. Suboptimal results were significantly lower for LTS-ES (6 of 118 eyes, 5.1%) compared to Wies (14 of 43 eyes, 32.6%; p<0.0001), Wies-R (7 of 28 eyes, 25%; p=0.0035), and both non-LTS-ES procedures combined (21 of 71 eyes, 29.6%; p=<0.0001). The proportion of cases requiring re-operations was not significantly lower for LTS-ES (3 of 118 eyes, 2.5%) compared to Wies-R (3 of 28 eyes, 10.7%; p=0.0848), but significantly lower compared to Wies (9 of 43 eyes, 20.9%; p=0.0004), and both non-LTS-ES procedures combined (12 of 71 eyes, 16.9%; p=0.0006).
The LTS-ES procedure was associated with higher rates of success with no suboptimal outcome (94.9%), compared to the Wies (67.4%) or Wies-R (75%) procedures. LTS-ES addresses lateral canthal tendon laxity and retractor attenuation, resulting in effective repair of involutional entropion. To our knowledge, our study is the first to directly compare surgical outcomes for LTS+ES, Wies and Wies-R procedures.
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