A Randomized Controlled Trial Comparing Everting Sutures with Everting Sutures and a Lateral Tarsal Strip for Involutional Entropion

doi:10.1016/j.ophtha.2009.06.056

Ophthalmology

Volume 117, Issue 2, February 2010, Pages 352-355

https://doi.org/10.1016/j.ophtha.2009.06.056 Get rights and content

Objective

To determine whether there is a statistically significant difference in the surgical outcome of everting sutures (ES) alone versus everting sutures with a lateral tarsal strip (ES+LTS) in the treatment of involutional entropion.

Design

Prospective randomized comparative trial.

Participants

Sixty-three patients with primary involutional lower eyelid entropion were enrolled in the study. The age range was 54 to 94 years, with a mean age of 77 years. Baseline characteristics of the comparative groups were similar.

Methods

Patients requiring primary surgical repair for involutional entropion were selected, and those providing informed consent were randomized for surgery. Thirty-six patients were randomized to ES alone, and 27 patients were randomized to ES+LTS. Patients were evaluated at 3 weeks and 6, 12, and 18 months postoperatively.

Main Outcome Measures

Successful surgery was defined as a normal eyelid position at rest and inability to induce entropion on tetracaine provocation testing at or before the 18-month follow-up visit.

Results

Eight patients were lost to follow-up (7 had ES alone). Of the 55 patients with complete follow-up data, there were 6 failed procedures in the patients who underwent ES alone and no failed procedures in the patients who underwent ES+LTS (P = 0.02).

Conclusions

These data provide strong evidence that success rates at 18 months are higher in patients treated with ES+LTS procedure compared with ES alone.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

From statistical analysis, the sample size calculation required 110 patients per treatment group to have 90% power to detect a significant difference between the 15% entropion recurrence rate reported by Wright et al⁷ for ES and the 2% entropion recurrence rate reported by Barnes et al⁶ for ES+LTS. We therefore designed a multicenter trial and set out to recruit in excess of 110 patients from 5 treatment centers, but lack of research staff resulted in 2 hospitals withdrawing from the study

Results

Sixty-three patients were enrolled in the study (mean age 77 years, range 54–94). Of the 63 patients, 8 had incomplete follow-up and were excluded from analysis. Of these 8 patients, 4 died before 18 months follow-up, 2 refused surgery after entry into the study, 1 requested to withdraw from the study after having had surgery, and 1 was lost to follow-up. Of the remaining 55 patients, 48 were reviewed by an ophthalmologist and 7 were reviewed by a general practitioner. Both the ES and ES+LTS

Discussion

To the best of our knowledge, this is the first randomized comparative study comparing the relative efficacy of treating involutional entropion with ES alone or with ES+LTS. Everting sutures alone have been shown to be an effective, simple, and safe treatment for involutional entropion with a long-term recurrence rate of 15% (mean follow-up 31 months).⁷ The ES+LTS procedure has a variable success rate recorded in the literature. Barnes et al⁶ assessed ES+LTS and found a recurrence rate of 2%

Conclusions

Our study provides strong evidence that ES+LTS is more effective than ES alone for correcting involutional entropion. Addressing both the horizontal and the vertical lower eyelid laxity in patients with involutional entropion seems to have a more long-lasting effect on maintaining lower eyelid stability; however, for patients in whom performing LTS surgery is not practical, ES alone may be indicated because of its immediate effect, simplicity to perform, and relatively high success rate. The

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Wedge resection of the tarsal plate combined with the modified Hotz procedure for correction of involutional lower eyelid entropion
2019, Canadian Journal of Ophthalmology
Citation Excerpt :
Also contributing to the condition is the overlapping of the preseptal orbicularis muscle with the pretarsal orbicularis muscle.1 Scheepers et al. conducted a prospective randomized trial that compared the efficacy of everting sutures combined with a lateral tarsal strip with the efficacy of everting sutures alone in the treatment of involutional entropion.7 There was no recurrence during the 18-month follow-up of any of the patients with everting sutures combined with a lateral tarsal strip.
To investigate the outcomes for correction of involutional lower eyelid entropion by wedge resection of the tarsus combined with the modified Hotz procedure.
Retrospective study.
Patients with lower eyelid involutional entropion that was surgically repaired by wedge resection of the tarsal plate combined with the modified Hotz procedure.
In a consecutive series of 43 patients with involutional lower eyelid entropion, wedge resection combined with the modified Hotz procedure was performed with an average follow-up period of 29.6 months (range, 6–62 months).
Among the patients, 93% had an excellent outcome within the follow-up period. For one patient, the outcome of both eyes was poor. For another patient, incision dehiscence of the eyelid margin in one eye occurred after the stitches were removed. The incision was sutured again, and it healed well. One patient complained of foreign body sensation in one eye after removal of the skin stitches. The complaint was resolved after wearing a corneal contact lens. No other significant complications occurred.
In our clinic, tarsal plate wedge resection combined with the modified Hotz procedure has been highly effective for correction of involutional lower eyelid entropion. Although this approach does not directly address lateral canthal tendon laxity, it does preserve the eyelid in case there is a future need for reconstruction due to ocular surface disease or trauma. Thus, wedge resection of the tarsal plate combined with modified Hotz procedure is a safe and effective method for involutional lower eyelid entropion.
Examiner les résultats de la correction d’un entropion involutionnel de la paupière inférieure par résection cunéiforme du tarse associée à une technique modifiée de Hotz.
Étude rétrospective.
Patients dont l’entropion involutionnel de la paupière inférieure a fait l’objet d’une correction chirurgicale reposant sur une résection cunéiforme du tarse associée à une technique modifiée de Hotz.
Dans une série de 43 patients consécutifs présentant un entropion involutionnel de la paupière inférieure, on a procédé à une résection cunéiforme du tarse associée à une technique modifiée de Hotz; le suivi moyen a été 29,6 mois (écart: 6-62 mois).
Le traitement a donné d’excellents résultats chez 93 % des patients pendant la période de suivi, sauf chez un patient, dont les résultats ont été médiocres dans les deux yeux. Chez un autre patient, il s’est produit une déhiscence de la plaie sur le bord de la paupière dans un œil après le retrait des points de suture. L’incision a été suturée à nouveau et a bien cicatrisé. Un patient s’est plaint d’une sensation de corps étranger dans un œil après le retrait des points de suture. La sensation a disparu lorsque le sujet a commencé à porter une lentille cornéenne. Aucune autre complication notable n’est survenue.
Dans notre clinique, la résection cunéiforme du tarse associée à une technique modifiée de Hotz s’est révélée très efficace pour corriger l’entropion involutionnel de la paupière inférieure. Bien que cette intervention ne règle pas directement le problème de laxité du tendon du canthus latéral, elle permet de conserver la paupière au cas où il deviendrait nécessaire de réaliser une reconstruction en raison d’une atteinte de la surface oculaire d’origine pathogène ou traumatique. Ainsi, la résection cunéiforme du tarse associée à une technique modifiée de Hotz est une méthode sûre et efficace pour corriger l’entropion involutionnel de la paupière inférieure.
Horizontal eyelid shortening alone versus combined procedures for the correction of involutional lower eyelid entropion
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Transconjunctival Approach for Involutional Entropion: Suggestions and Drawbacks
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Outcomes of combined procedures compared to various single techniques for involutional entropion
2023, Oman Journal of Ophthalmology
A novel surgical correction technique of involutional entropion by combined triangular tarsectomy, orbicularis muscle tightening and inferior retractor plication
2023, European Journal of Ophthalmology
Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience
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: Manuscript no. 2008-1188.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Original articleA Randomized Controlled Trial Comparing Everting Sutures with Everting Sutures and a Lateral Tarsal Strip for Involutional Entropion

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Materials and Methods

Results

Discussion

Conclusions

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Involutional entropion: a review with evaluation of a procedure

Arch Ophthalmol

Mechanics and histology of senile entropion

Br J Ophthalmol

Senile entropion: pathogenesis and treatment

Arch Ophthalmol

Original article
A Randomized Controlled Trial Comparing Everting Sutures with Everting Sutures and a Lateral Tarsal Strip for Involutional Entropion