The use of a polyglactin suture in the lateral tarsal strip procedure

PURPOSE: To evaluate the rate of recurrence of horizontal laxity or lid malposition and suture-related complications associated with the use of an absorbable suture in the lateral tarsal strip procedure. DESIGN: Prospective, interventional, consecutive case series. METHODS: A prospective study. SETTING: Institutional. PATIENT POPULATION: One hundred patients with horizontal lid laxity associated with ectropion or entropion. Patients with paralytic ectropion or ocular prostheses were excluded. INTERVENTION: One hundred and five lateral tarsal strip procedures were performed using a 6-0 polyglactin suture. These were combined with full-thickness skin grafts (34), internal (55) or external (23) retractor plications, and inverting sutures (4) as required to correct the lid malposition. MAIN OUTCOME MEASURES: Recurrence of horizontal laxity or lid malposition and suture related complications were the main outcome measures. Suture related wound infection was diagnosed clinically by the presence of pus associated with wound breakdown. RESULTS: One patient failed to reach 3-month follow-up and was excluded. There was one recurrence of horizontal laxity after a mean follow-up period of 9.1 months. Four patients developed lateral canthal wound infections, compared with none at the other operative sites. The 95% confidence intervals for infections in the tarsal strip procedure were 1.1% to 9.6%, which were significantly greater than zero (P < .0001), the infection rate for the other procedures. CONCLUSION: A 6-0 absorbable suture may be used for the lateral tarsal strip and does not lead to a recurrence of horizontal laxity. It does not appear to reduce the wound infection rate associated with this procedure.     

The tarsal sandwich: a new technique in lateral canthoplasty

PURPOSE: Trauma and infection sometimes produce lower lid malpositions that are difficult to repair cosmetically with standard canthoplasty techniques. A new variation is described. METHODS: Surgical techniques of the tarsal strip canthoplasty and of lateral tarsorrhaphy are combined into the tarsal sandwich. RESULTS: Representative cases with preoperative and postoperative photos are presented. CONCLUSION: The sandwich technique allows the surgeon more flexibility in achieving the necessary vertical lift of the lateral canthus in difficult cases of entropion, ectropion, and lagophthalmos.     

Involutional entropion repair with fornix sutures and lateral tarsal strip procedure

PURPOSE: To evaluate the long-terrm effectiveness of fornix suture placement combined with a lateral tarsal strip procedure in correcting involutional entropion. Published reports regarding various surgical techniques and results are reviewed. METHODS: This retrospective study reviewed 119 patients with involutional lower eyelid entropion who underwent surgical repair between January 1987 and May 1999 at the Bascom Palmer Eye Institute. Exclusion criteria included follow-up duration of less than 6 months, previous lower eyelid blepharoplasty, previous conjunctival surgery other than chalazion removal, or cicatricial entropion. The three surgical subsets were (1) combined lateral tarsal strip and fornix sutures: (2) fornix sutures alone; and (3) lateral tarsal strip procedure alone. The chart review was complemented by a telephone questionnaire to assess the long-term clinical outcome, complications, and patient satisfaction. RESULTS: One hundred fifty-two eyelids in 119 patients were included. One hundred twenty-five eyelids had combined surgery (lateral tarsal strip with fornix sutures), 9 eyelids had only fornix suture repair, and 18 eyelids had repair with only the lateral tarsal strip procedure. The recurrence rate in these three surgical subsets was 1.6%, 33%, and 22%, respectively, with average follow-up of 36 months. One case of incisional cellulitis was encountered. Postoperative ectropion was not seen in the group having the combined lateral tarsal strip and fornix suture procedure. CONCLUSIONS: Suture advancement of the lower eyelid retractors in conjunction with a lateral tarsal strip procedure is a simple, quick, physiologic, and effective approach in achieving long-lasting correction for involutional entropion.     

A tarsal strip-periosteal flap technique for lateral canthal fixation

Lateral canthal fixation is widely used. This article sought to determine if a periosteal flap used routinely in conjunction with a tarsal strip provides lasting lateral canthal fixation. This consecutive clinical series from two ambulatory surgery centers followed 79 patients who underwent 141 lateral canthal fixation procedures. Outcome was measured by the position of the lateral canthus. Correct positioning of the lateral canthus was achieved in 78 of 79 patients representing 139 of 141 procedures (98%). The failed case was a patient with floppy eyelid syndrome in whom the sutures tore through the tarsal strips. The tarsal strip-periosteal flap technique is a successful, technically direct method of lateral canthal fixation. It is promoted as an enhancement of the tarsal strip technique, and is especially helpful in patients with prominent eyes.     

外侧睑板条悬吊联合下睑缩肌前徙术治疗老年性睑内翻

目的:观察和评价外侧睑板条悬吊联合下睑缩肌前徙术治疗老年复杂性睑内翻的方法及疗效。方法:老年性睑内翻患者主要病因有:眼睑松弛、下睑缩肌张力降低、眼轮匝肌变化,根据病因选择患者使用外侧睑板条悬吊联合下睑缩肌前徙术,术中观察眼睑位置不可过度外翻。结果:本组19例31眼诊断老年复杂性睑内翻的患者行外侧睑板条悬吊联合下睑缩肌前徙术,随访8～50mo,疗效确切。结论:外侧睑板条悬吊联合下睑缩肌前徙术是治疗老年复杂性睑内翻的有效方法。     

Correction of involutional lower eyelid medial ectropion with transconjunctival approach retractor plication and lateral tarsal strip

AIM: We describe the technique and our results in managing lower eyelid involutional medial ectropion using a combination of lateral tarsal strip to address horizontal eyelid laxity, and transconjunctival inferior retractor plication to address inferior retractor dehiscence. METHODS: Patients with symptoms of epiphora or signs of medial ectropion were offered this procedure. All had the following characteristics: medial lower eyelid eversion, punctal eversion >3 mm, medial canthal tendon laxity <4 mm, significant horizontal eyelid laxity and lacrimal systems that were patent to syringing. RESULTS: A total of 24 eyelids of 17 patients underwent this procedure over a 12-month period. The mean age of the patients was 79.7 years; 11 were male and six were female. The mean follow-up time was 18 months. Two eyes had undergone previous surgery. All patients had restoration of the eyelid margin to the globe and relief of symptoms. No complications were noted. DISCUSSION: These results suggest that excision of posterior lamellar tissue is not necessary for correction of involutional medial ectropion. Transconjunctival plication or reattachment of retractors is easy to perform and allows for the repair of more than the medial portion of the retractors if required.     

Idiopathic loss of lateral tarsal suspension

CASE: A 53-year-old man who showed a loss of tarsal suspension in the lateral third of both lower eyelids underwent lateral canthoplasty with a good post-operative result. DISCUSSION: Disinsertion of the union of the inferior tarsus with the lateral canthus, of unknown cause, is a very uncommon finding that has almost never been reported in the world literature. There are two cases described of eyelid elastolysis with loss of lateral tarsal suspension, as in our case, but both showed eyelid skin atrophy and had histopathologic confirmation. Our case did not have skin atrophy.     

探讨Medpor下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻

目的　探讨Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻的临床疗效。方法　回顾性系列病例研究。收集１６例（１６眼）重度麻痹性下睑外翻患者的临床资料,所有患者均采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗。记录并比较１６例患者术前及术后１周、３个月、１２个月的眼睑闭合不全量、下睑退缩量、角膜上皮分级、下睑水平及垂直松弛度等级。结果　１６例患者术后下睑外翻均矫正,随访期内均未见复发。术后１周、３个月、１２个月,下睑退缩量、眼睑闭合不全量均较术前明显下降,差异均有统计学意义（均为Ｐ＜０．０５）;术后各时间点间比较,差异均无统计学意义（均为Ｐ＞０．０５）。随访期间各患者的角膜上皮分级、水平及垂直松弛度等级均较术前明显改善,随访期末均为０级或１级。无１例患者术后出现眶内出血、感染及内植入物暴露、排斥、移位等严重并发症。结论　采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻,可在保留患者视功能的前提下矫正下睑外翻及眼睑闭合不全,有效改善患者眼表状况及外观,且术后效果较为稳定。     

经结膜下睑缩肌折叠联合外眦睑板条固定矫正退行性下睑外翻的疗效观察

目的 探讨经结膜下睑缩肌折叠联合外眦睑板条固定术治疗退行性下睑外翻的效果。设计回顾性病例系列。研究对象北京同仁医院眼科退行性下睑外翻患者13例(13眼)。方法 回顾患者的病历资料。所有患眼均采用经结膜入路,将下睑缩肌折叠缝合于睑板下缘;联合外眦睑板条固定。术后平均随访时间(7.1±2.5)个月。主要指标眼睑形态、睑缘位置、眼睑水平及垂直松弛度。结果 最后随访时所有患者下睑外翻得到矫正,患者外观及症状明显改善。外翻程度从术前的Ⅱ～Ⅳ级降至术后为0～Ⅰ级(Z=-4.652,P<0.0001)。术前下睑垂直松弛度为(7.04±0.52)mm,最后随访时为(4.31±0.51)mm(t=22.45,P<0.0001)。术前水平松弛度为(9.5±0.91)mm,最后随访时为(5.19±0.52)mm(t=19.96,P<0.0001)。所有患者未发生过矫、复发、缝线脓肿、伤口异常或下穹窿变浅。结论 本小样本量研究结果 显示,经结膜折叠下睑缩肌联合外眦睑板条固定术是矫正退行性下睑外翻的简单有效方法 。(眼科,2022,31:315-318)     

Microscopic findings of lateral tarsal fixation in Asians

PURPOSE: To identify microscopically lateral tarsal fixation in Asians. METHODS: Specimens from 19 postmortem lateral eyelids and orbits of 11 Asians (11 right, 8 left; aged 45-96 years at death) were used. Samples damaged on sectioning and samples without tarsal plates were excluded. The samples were fixed in 10% buffered formalin and examined under a microscope. Two levels of tarsus were observed in the upper and lower eyelids, suggesting the possibility of different means of fixation. The first and second sections, which were incised parallel to the eyelid margin, were obtained at 1 mm and 5 mm from the upper eyelid margin, and at 1 mm and 3 mm from the lower eyelid margin. The sections were stained with Masson trichrome. RESULTS: The first sections of all upper eyelids and those of the lower eyelids except one showed tarsal fixation by both the lateral rectus capsulopalpebral fascia (lr-CPF) and the tendon-ligament complex of the lateral canthal tendon (LCT), which in several cases received the muscle of Riolan. The second sections of all upper eyelids showed fixation by the lr-CPF and the ligamentous part of the LCT. The second sections of the lower eyelids were mostly similar to the second sections of upper eyelids, though some showed only ligamentous fixation. The lr-CPF in all cases included a small amount of smooth muscle fibers. CONCLUSIONS: The lateral aspect of the tarsus is supported by the lr-CPF and the LCT, which in some cases includes the muscle of Riolan.     

A new instrument to aid the lateral tarsal sling procedure

We describe a new surgical instrument and its use in the lateral tarsal sling procedure. We reviewed the charts of 23 cases of such surgery over 5 years and found its use to be an effective means of correcting horizontal eyelid laxity, with a low rate of complications. This approach provides a safe and effective alternative to the lateral tarsal strip procedure.     

异体巩膜条睑板延长术治疗复发性瘢痕性睑内翻

目的：探讨异体巩膜条睑板延长术治疗复发性瘢痕性上睑内翻的手术疗效。方法：对27例(36只眼)复发性瘢痕性上睑内翻患者采用从睑板沟切断睑板的方法，在睑板铁损区嵌入异体巩膜条，延长睑板，松解瘢痕。结果：28只眼内翻矫正，8只眼复发，3只眼再次手术后矫正。结论：采用异体巩膜条睑板延长术治疗复发性瘢痕性眼睑内翻，手术方法简便，损伤小，可反复操作，疗效满意，异体巩膜易于获得及保存，是一种值得推广的手术方法。     

Excision of nodular basal cell carcinoma involving the lower eyelid tarsal skin using a grey line-splitting,posterior lamella-sparing technique

Purpose: To describe a posterior lamella-sparing technique to resect nodular basal cell carcinoma involving the inferior part of the tarsal skin of the lower eyelid.

Surgical Technique: Excision of nodular basal cell carcinoma of the tarsal skin using a grey-line-splitting technique with preservation of the posterior lamella. Specimen was sent for frozen section control. Additional excision was performed in caseof irradicality. The defect was closed with a free skin graft from the ipsi- or contralateral upper eyelid.

Results: We show a case series of three patients with lower eyelid basal cell carcinoma and investigated radicality on histology, aesthetic outcome and clinical recurrence during a follow-up of 18 months. Pre, intra, and postoperative photographs were obtained. In all cases radicality was reached. In all patients, the skin graft was viable, with no recurrence after 18 months. Excellent aesthetic results were obtained.

Conclusion: Anterior lamellar resection of nodular basal cell carcinomas involving the tarsal lower eyelid skin using a grey line lid-splitting technique is a simple and one-step technique with good clinical outcome. It may avoid the morbidity associated with full thickness eyelid resection and might be useful for other, nonmalignant eyelid lesions.     

Modified treatment of distichiasis with direct tarsal strip excision without mucosal graft

Purpose: To describe a new modified technique of direct tarsal excision for treatment of distichiasis.

Methods: Retrospective review of consecutive patients who underwent direct tarsal excision without grafting to treat distichiasis between December 2007 and November 2015. Gender, number of eyelids treated, follow-up time, and surgical outcome were recorded. The technique involved dividing the anterior and posterior lamella and excising a two mm tarsoconjunctival strip including the abnormal lash follicles, without suturing or mucosal graft.

Results: Seventeen eyelids of 12 patients (Fourteen upper eyelids and 3 lower eyelids) were studied. Sixteen eyelids had acquired distichiasis and one eyelid had congenital distichiasis. Mean age was 64.8 (SD 22.0; range, 25–86 years) Mean postoperative follow-up time was 53 months (SD = 31, range 8 – 104 months). During this period, no recurrence was documented. There were no complications.

Conclusions: Direct tarsal excision without a graft is a safe, quick, and effective method for the treatment of distichiasis.     

Lateral tarsal strip plus skin-muscle flap excision in the treatment of lower eyelid involutional entropion

This article examines the effectiveness of skin-muscle flap excision in conjunction with a lateral tarsal strip for the treatment of involutional entropion. Ninety-six eyelids in 83 consecutive patients with involutional entropion were treated using a standardized surgical procedure. All patients underwent lower eyelid tightening with a lateral tarsal strip, dissection of a skin-muscle flap inferiorly through a subciliary incision and excision of redundant skin as well as orbicularis muscle. Follow-up data was obtained by retrospective chart review and telephone interviews. 80 patients were included in this study. The only exclusion criteria was failure to attend the 1 week follow-up appointment, n = 3. There was only one recurrence which was mild and revised under local anesthesia. Two patients had overcorrection with mild ectropion but did not require additional surgery. In those that completed their initial post-operative visit, the average time follow-up time was 502 days. Excision of a skin-muscle flap is a useful addition to lateral tarsal strip surgery in the treatment of involutional entropion and is a quick procedure producing excellent functional and cosmetic results. To our knowledge, this is the first cohort of patients to be reported using this technique where all patients had a standardized surgical approach. Additional studies are needed to compare long-term outcomes of this technique against other surgical treatments.     

下睑缩肌复位联合外侧睑板条固定术治疗退行性下睑内翻

目的：探讨并比较下睑缩肌复位联合外侧睑板条固定术及单纯下睑缩肌复位术治疗退行性下睑内翻的有效性和安全性。

方法：本研究为前瞻性研究。选取2015-01/2018-02在我科接受手术治疗的退行性下睑内翻患者79例91眼,随机分为观察组(41例46眼,行下睑缩肌复位联合外侧睑板条固定术)和对照组(38例45眼,行单纯下睑缩肌复位术),对两组临床疗效、术后并发症发生率进行比较。

结果：术后3mo随访,两组患者治愈率无差异(100% vs 98%,P=0.495)。术后24mo随访,观察组治愈率高于对照组(98% vs 84%,P=0.030)。观察组无术后并发症发生,明显少于对照组(11%,P=0.026)。

结论：下睑缩肌复位联合外侧睑板条固定术治疗退行性下睑内翻较单纯下睑缩肌复位术远期治疗效果佳,并发症少。