Lateral tarsal strip through osteotomies for recurrent ectropion and eyelid laxity correction

Objective to present a surgical technique for treating patients with recurrent ectropion and severe lower eyelid laxity. Methods Lateral tarsal strip and canthal fixation by osteotomy was performed in 6 patients with recurrent ectropion and 1 patient with extreme lower eyelid laxity secondary to an anophthalmic socket. Preoperative and postoperative photographs were evaluated in order to assess the outcomes of the procedure. Patients were followed up 4 weeks, 6 months, 12 months and 24 months of the postoperative period. The initial symptoms of the patients were eye redness, epiphora, foreign body sensation, aesthetic complaints, and facial asymmetry. Symptoms and aesthetic results were assessed by questioning, photographs, and fluorescein and lissamine green stains taken in each visit. Results No postoperative complications were observed. No recurrence episodes were reported during the follow-up period and physical appearance improvement and symptom severity reduction were maintained during the observation. Conclusion Lateral tarsal strip through osteotomies is an effective surgical procedure for treating severe recurrent ectropion cases or lower eyelid laxity and could be considered as an alternative treatment option or even a primary surgical technique in selected difficult cases.

The Lateral Tarsal Strip Procedure: Reflections by a Specialist With 20 Years of Experience in a Tertiary Medical Center (Cross-sectional Study)

Introduction: Lateral tarsal strip (LTS) is a simple surgical technique that can correct eyelid malposition. Clinical indications vary from involutional entropion and ectropion, lower lid laxity, and lower lid retraction to punctal and paralytic ectropion. LTS mainly treats eyelid malposition by correcting horizontal laxity. Herein, we report the clinical indications for and effects of LTS.Methods: We retrospectively reviewed medical records of patients who underwent LTS by a single oculoplastic surgeon with eight years of experience performing the procedure at Korea University Guro Hospital.Results: We included 247 patients with 325 treated eyelids in the study. Involutional entropion was the most common indication, accounting for 69 patients (27.94%) and 88 eyelids (27.08%). The second most common indication was lower lid laxity (n=44 patients (17.81%) and 68 eyelids (20.92%)). Simultaneous surgery in addition to LTS was performed in 167 patients (67.6%) and 219 eyelids (67.4%); the most common was endoscopic dacryocystorhinostomy (DCR), which was performed in 50 patients (29.94%) and 80 eyelids (36.53%). Conclusion: LTS can be performed alone or simultaneously with oculoplastic procedures for various indications. Overcorrection with fixation above the canthal angle is useful to reduce recurrence. This study aims to explain the clinical importance of the LTS procedure.

The effects of using spacer grafts on lower-eyelid retraction surgery in patients with facial nerve palsy

Purpose To evaluate the effects of the concomitant use of spacer grafts in lateral tarsal strip surgery in patients with facial nerve palsy-related lower-eyelid retraction. Methods Patients who underwent lateral tarsal strip surgery to correct facial nerve palsy-related lower-eyelid retraction were retrospectively reviewed. Postoperative decreases in marginal reflex distance-2 values at 1, 2 and 6 months were measured along with the effects of spacer grafts. Results Forty-five patients (28 males) were included (mean age: 59.56 years). Mean preoperative marginal reflex distance-2 was 6.87 ± 1.34 mm. Twenty patients underwent lateral tarsal strip surgery only (lateral tarsal strip-only); 25 patients underwent lateral tarsal strip surgery using spacer grafts (lateral tarsal strip + graft). Median (interquartile range) follow-up duration was 12.0 (6.0–23.0) months. Retraction was significantly improved and maintained at 1, 2 and 6 months postoperatively in all patients (mean marginal reflex distance-2: 3.78 ± 1.06 mm, 4.30 ± 1.23 mm and 4.72 ± 1.11 mm, respectively). Surgical outcomes were significantly better in the lateral tarsal strip + graft than in the lateral tarsal strip-only group (Δmarginal reflex distance-2: 3.92 vs. 2.05 mm at 1 month, p < 0.001; 3.38 vs. 1.61 mm at 2 months, p = 0.001; 2.88 vs. 1.69 at 6 months, p = 0.042). Subgroup analyses by spacer graft type revealed no significant differences. Conclusion The concomitant use of spacer material in lateral tarsal strip surgery yielded better surgical outcomes than lateral tarsal strip surgery alone. The use of spacer grafts should be considered for correcting severe facial nerve palsy-related lower-eyelid retraction.

Outcomes of Evisceration or Enucleation by Resident Trainees in Patients with Endophthalmitis or Panophthalmitis

Background To evaluate the outcomes of evisceration or enucleation with primary implantation performed by ophthalmology resident trainees in patients with endophthalmitis or panophthalmitis. Methods In this retrospective analysis, the clinical records of all patients diagnosed with endophthalmitis or panophthalmitis who underwent enucleation or evisceration with primary implantation over a 13-year period were reviewed. The predictive factors related to implant exposure or extrusion were identified using multivariate analysis. Results Sixty-six patients, with a median age of 46.8 years, were enrolled. Thirty-six (55%) out of 66 patients were diagnosed with panophthalmitis. The most common causes of endophthalmitis or panophthalmitis were trauma (13 patients) and corneal ulcer perforation (10 patients). Enucleation was performed in 53 patients (80%). Four patients (6%) had implant exposure, and 4 patients (6%) had implant extrusion. Multivariate analysis demonstrated that Pseudomonas aeruginosa infection (P = 0.021, adjusted odd ratio [aOR] 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P = 0.02, aOR = 30.11) were associated with implant exposure or extrusion. Patients with panophthalmitis who underwent evisceration had a higher rate of implant exposure or extrusion than those who underwent enucleation (P = 0.031, aOR 38.38). Other complications included socket discharge in 14 patients, lower lid laxity in 5 patients who underwent the lateral tarsal strip procedure, and wound dehiscence in 3 patients. At the last visit, 65 patients had successful prosthesis fitting. Conclusion This study suggests that evisceration or enucleation with primary implant placement in patients with recalcitrant endophthalmitis or panophthalmitis can be performed by resident trainees with acceptable surgical outcomes and a low rate of serious complications.

Outcome of Lateral tarsal strip (LTS) procedure in the correction of eyelid malposition

To analysis the effectiveness of lateral tarsal strip for the surgical repair of the marginal malpositions of the lower eyelid. A retrospective, consecutive case series of patients who underwent lateral tarsal strip (LTS) procedure for all types of involutional lower eyelid malposition (entropion and ectropion) and paralytic ectropion, at one tertiary eye centre of Dhaka, Bangladesh, between January 2013 and December 2017. All records were evaluated to determine the indications, management strategies, surgical outcome and postoperative complications. A total of 46 lower eyelids marginal malposition’s of 41 patients were studied in this study and lateral tarsal strip 9LTS) procedure was used to repair the involutional entropion (52%), involutional ectropion (35%), and paralytic ectropion (13%) of the lower eyelid. The male to female ratio was 2:1. The mean age was 61.34 years with 26 years to 85 years age range. The surgical correction was satisfactory in 93.5% cases. Lateral tarsal strip (LTS) procedure achieved statistically significant better anatomical and functional outcomes for the correction of all types of involutional eyelid marginal malposition’s and paralytic ectropion.