ANTERIOR LAMELLAR MARGINAL Z-PLASTY WITH TRANSVERSE TARSOTOMY FOR MANAGEMENT OF TRICHIASIS WITH CICATRICIAL ENTROPION -A NEW SURGICAL APPROACH
Abstract
Background: Trichiasis is the main risk factor for corneal opacification. The primary treatment oftrichiasis 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
References
Sandford-smit J. Surgery of the eye lid. In: Eye surgeries in hot
climate. 3rd ed. London: FA Thorpep; 2004.p. 212-56.
Burton MJ, Bowman RJ, Faal H, Aryee EAN, Ikumapayi UN,
Alexander NDE, et al. Long term outcome of trichiasis surgery in
the Gambia. Br J Ophthal 2005;89:575-9.
Burton MJ, Kinteh F, Jallow O, Sillah A, Bah M, Faye M, et
al. A randomized controlled trial of azithromycin following
surgery for trachomatous trichiasis in the Gambia. Br J
Ophthal 2005;89:1282-8.
Woreta TA, Munoz BE, Gower EW, Alemayehu W, West SK. E
ffect of Trichiasis surgery on visual acuity outcomes in
Ethiopia. Arch Ophthalmol 2009;127:1505-10.
Kanski JJ. Eyelids. In: Kanski JJ, (Ed.) Clinical ophthalmology.
th ed. Edinburgh: Butterworth Heinemann; 2009.p. 133-40.
Reacher M, Foster A, Huber J. Trichiasis Surgery for Trachoma:
the Bilamellar Tarsal Rotation Procedure. Geneva: World
HealthOrganization1993,WHO/PBL/93.29. Available at:
http://whqlibdoc.who.int/hq/1993/WHO_PBL_ 93.29.pdf.
Kerie A, Bejiga A. Pattern of recurrence of trachomatous
trichiasis after surgery in Enemor and Ener district, Central
Ethiopia. Ethiop Med J 2010;48(4):301-8.
Thylefors B, Dawson, CR Jones BR, West SK, Taylor HR. A
simple system for the assessment of trachoma and its
complications' Bull World Health Organ 1987;65(4):477-83.
Mariotti S, Pascolini D, Rose-Nussbaumer J. Trachoma: global
magnitude of a preventable cause of blindness. Br J Ophthalmol
;93:563-8.
Ti S, Tow SL, Chee SP. Amniotic membrane transplantation in
entropion surgery. Ophthalmology 2001;108:1209-17.
El Toukhy E, Lewallen S, Courtright P. Routine bilamellar tarsal
rotation surgery for trachomatous trichiasis: short-term outcome
and factors associated with surgical failure. Ophthal Plast
Reconstr Surg 2006;22(2):109-12.
Khandekar R, Mohammed AJ, Courtright P. Recurrence of
trichiasis: a long-term follow-up study in the Sultanate of Oman.
Ophthalmic Epidemiol 2001;8(2-3):155-61.
Rajak SN, Makalo P, Sillah A,Holland MJ, Mabey DCW, Bailey
RL, et al. Trichiasis Surgery in The Gambia: A 4-Year
Prospective Study. Invest Ophthalmol Vis Sci
;51(10):4996-5001.
Win N. Grey line split surgery in trichiasis. Rev Int Trach Pathol
Ocul Trop Subtrop 1976;53:111-28.
Shalaby SA, Wies procedure combined with anterior lamellar
recession in the management of cicatricial entropion of the upper
eyelid. Egyptian J Hosp Med 2011;42:103-8.
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