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Comparison of four Combined Procedures for Correction of Involutional Lower Eyelid Entropion

Poon, Jia Shin, BMBS*; Vahdani, Kaveh, FRCOphth; Thaller, Vladimir Theodor, FRCOphth, FRCS

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1239–1244
doi: 10.1097/SCS.0000000000005466
Clinical Studies

Background: To evaluate 4 combined techniques for entropion repair which address the horizontal laxity by either lateral tarsal strip (LTS) or Bick's procedure (BP) and the vertical laxity by everting sutures (ESs) or lower lid retractor plication (LLRP).

Methods: Retrospective, comparative consecutive clinical series. A total of 261 procedures were performed on 227 patients. Patients were divided in the following groups based on the procedure type: Group 1: LTS + ES (n = 115), Group 2: LTS + LLRP (n = 77), Group 3: BP + ES (n = 25), and Group 4: BP + LLRP (n = 44).

Results: The study cohort included 132 males and 95 females. The mean age was 76.2 ± 8.3 years. The mean follow-up was 13 months (range 3–58). At last follow-up, the cure rate was 92% in the LTS + ES and 90% LTS + LLRP groups, in contrast to 100% in BP + ES and BP + LLRP groups (P = 0.035). Overcorrection was observed in 2 patients from LTS + ES and 5 from LTS + LLRP group. There was no statistically significant difference in terms of symptoms outcomes among 4 groups. Complications were relatively minor with no statistically significant difference between the 2 groups (P = 0.13). The reoperation rate was 7% and 6.5% in groups 1 and 2 (P = 1.0), respectively, to none in groups 3 and 4.

Conclusion: Bick's procedure in conjunction with either ES or LLRP, provides a quick, simple, and effective means for addressing the main pathogenic factors of involutional entropion. This study found a lower recurrence rate and consecutive ectropion formation in Bick's compared to LTS groups.

*Maidstone and Tunbridge Wells NHS Trust, Pembury, Tunbridge Wells

Moorfields Eye Hospital, London

Royal Eye Infirmary, Derriford Hospital, Plymouth, UK.

Address correspondence and reprint requests to Kaveh Vahdani, FRCOphth, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; E-mail:

Received 23 December, 2018

Accepted 11 February, 2019

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.