ANTERIOR LAMELLAR MARGINAL Z-PLASTY WITH TRANSVERSE TARSOTOMY FOR MANAGEMENT OF TRICHIASIS WITH CICATRICIAL ENTROPION —A NEW SURGICAL APPROACH

Zulfiquar Ali, Danish Zaffar, Hassan Sajid Kazmi, Ashfaq Ali Shah

Abstract


Background: Trichiasis is the main risk factor for corneal opacification. The primary treatment of
trichiasis is surgical. Successful surgery is likely to halt the progression of corneal opacity. The aim of
the study is to report the efficacy of the anterior lamellar marginal z-plasty combined with transverse
tarsotomy in the management of severe trichiasis andcicatricial entropion of upper eyelid. Methods: A
prospective study was carried out from January 2009 to June 2012, on 54 eyelids (44 patients) who
underwent anterior lamellar marginal z-plasty with transverse tarsotomy for correction of trichiasis and
cicatricial entropion involving upper eyelid with a minimum of 6 months’ follow-up. Results were
classified according to the presence and location of residual trichiasis and symptoms were assessed
according to a three-level subjective scale (better, worse or no change). Failure was defined as recurrent
trichiasis with one or more lashes touching any part of cornea in primary position. Secondary outcomes
were visual acuity and corneal opacification. Results: At the end of six month period, none of patients
had any trichiatic eye lash touching the cornea in primary position (100% success). Forty-eight (88.9%)
of the operated eyelids were free of trichiasis, while residual trichiasis was noticed only in 6 (11.1%)
operated lids. At the end of six months, there was a significant reduction of lash burden from median of
12 trichiatic lashes from the base line to the median of 2. All the patients reported significant reduction
in symptoms of irritation. Significant improvement in visual acuity (p<0.000) and reduction in the
density of corneal opacity (p<0.000) was notified from the base line. Conclusion: Anterior lamellar
marginal z-plasty combined with transverse tarsotomy seems to have promising surgical outcome for
the correction of trichiasis and cicatricial entropion secondary to cicatricial trachoma.
Keywords: Cicatricial ectropion, trichiasis, trachoma

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