Clinical Ophthalmology (Aug 2023)
Modified Anterior Lamellar Recession for All Grades of Upper Eyelid Trachomatous Cicatricial Entropion
Abstract
Ezzat Nabil Abbas Ibrahim,1,* Ehab Tharwat,2,* Mahmoud Mohammed Ahmed Ali Khalil,1 Ahmed Rabie Mohammed,1 Mostafa F Mohammed,1 Ahmed Mohammed Madinah Alkady,1 Ezzeldin Ramadan Ezzeldin,2 Riad Elzaher Hassan Ahmed,2 Yasser H Al-Faky,3 Mohamed Hassanein,1 Ahmed N Elsayed,1 Mohammed Eid Abd El-Salam1,* 1Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 2Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt; 3Department of Ophthalmology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudia Arabia*These authors contributed equally to this workCorrespondence: Ehab Tharwat, Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Alkawthar Building at Alshenawy St, from Algeish St, Mansoura, Dakahlia, Egypt, Tel +20 10 06952497, Fax +20 50 2507370, Email [email protected]: This study aims to assess the combination of anterior lamellar recession (ALR) with blepharoplasty, suprasternal fixation, and internal eyelash bulb extirpation of aberrant lashes posteriorly located in patients with any grade of upper eyelid trachomatous cicatricial entropion.Patients and Methods: We reviewed the clinical data of eighty-six patients (143 eyelids) including age, gender, systemic medical illnesses, and comprehensive ophthalmological assessment. Eyelid evaluation was recorded, including laterality, previous surgical technique used, possible trichiasis etiology, abnormality of the lid margin, tarsal plate consistency (shrinkage or loosening), skin fold overhanging, laxity of the pretarsal skin, margin reflex distance 1 (MRD1), lagophthalmos, and lid retraction. The success rate was assessed at 3, 6, 9, and 12 months postoperative.Results: The success rate was 97.2% in the third month, which decreased significantly to 92.3% in the 6th month and 90.2% in the 9th month (P = 0.01, and 0.001 respectively). In the 9th month, we had fourteen failed cases. All of them were submitted for a second intervention. Three underwent electrolysis, four cases underwent re-internal bulb extirpation, four cases underwent the same procedure, and three cases underwent epilation. The success of the failed cases after the second intervention was significantly associated with the type of reintervention (P = 0.03), in which all of them succeed except two cases that underwent epilation. Kaplan-Meier analysis showed that the mean recurrence time in our study was 6.8 months (95% CI = 5.8– 7.7 months).Conclusion: This study showed the combination of ALR with blepharoplasty, suprasternal fixation, and cauterization or internal bulb extirpation of posteriorly located lashes procedure resulted in a high success rate in patients with any form of UCE with no increase in incidence or degree of lagophthalmos associated with UCE.Keywords: anterior lamellar recession, ALR, blepharoplasty, cicatricial entropion, suprasternal fixation
