Abstract
Purpose :
Involutional entropion correction usually involves lower lid retractor plication/reinsertion. In Asian patients, congenital entropion associated with epiblepharon has been corrected with modified Hotz procedure, without reinforcement of retractor. This method avoids the unwanted postoperative lower lid crease from aesthetic aspect. The enhanced adhesion between tarsal plate and subcutaneous tissue may also increase the stiffness of tarsus and help to overcome orbicularis muscle tone. Besides, aging lower retractors in Asians are usually thin, atrophy and not sufficient to rotate the direction of the lashes. Excessive tightening of the retractors can instead cause lid retraction. We investigate the outcome of this single method without combination of retractor reinsertion and lid tightening.
Methods :
Retrospective chart review. Modified Hotz procedure was performed soley. Pretarsal skin and orbicularis muscle were partially removed along subciliary incision. Several rotational sutures then anchor the subcutaneous tissue just beneath the lash base onto tarsal plate to evert the lash line.
Results :
From January 2019 to December 2021, 43 patients with 57 eyes were included (mean age: 67.89, range: 55-95 years old). The mean follow-up period was 10.56 months. (Range: 6-29months). After operation, immediate improvement of irritation, tearing and discharge were observed in all patients. 5 (8.7%) eyes presented slightly increased scleral show within 2mm. No patient presented ectropion due to overcorrection. Only one patient (one eye) recurred during the period of follow-up (7 months after surgery). This was mainly due to excessive lid laxity and after receiving lateral tarsal strip procedure, she achieved symptom relief. At the final follow-up, all patients were satisfied with the results. While 51 eyes (89.4%) reported complete remission, 6 eyes (10.5%) reported mild and easily tolerated symptoms.
Conclusions :
Involutional lower lid entropion can be corrected without retractor plication/reinsertion in certain Asian patients. It prevents from forming lower lid crease and may reduce tendency of overcorrection. The tarsal plate stability may be increased due to scar formation. Lower lid laxity should be evaluated before surgery with consideration of adding a lid tightening procedure. More case studies are needed to assess the outcomes and complications.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.