ANTERIOR LAMELLAR MARGINAL Z-PLASTY WITH TRANSVERSE TARSOTOMY FOR MANAGEMENT OF TRICHIASIS WITH CICATRICIAL ENTROPION —A NEW SURGICAL APPROACH
AbstractBackground: 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 ofthe study is to report the efficacy of the anterior lamellar marginal z-plasty combined with transversetarsotomy in the management of severe trichiasis andcicatricial entropion of upper eyelid. Methods: Aprospective study was carried out from January 2009 to June 2012, on 54 eyelids (44 patients) whounderwent anterior lamellar marginal z-plasty with transverse tarsotomy for correction of trichiasis andcicatricial entropion involving upper eyelid with a minimum of 6 months’ follow-up. Results wereclassified according to the presence and location of residual trichiasis and symptoms were assessedaccording to a three-level subjective scale (better, worse or no change). Failure was defined as recurrenttrichiasis with one or more lashes touching any part of cornea in primary position. Secondary outcomeswere visual acuity and corneal opacification. Results: At the end of six month period, none of patientshad 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 of12 trichiatic lashes from the base line to the median of 2. All the patients reported significant reductionin symptoms of irritation. Significant improvement in visual acuity (p<0.000) and reduction in thedensity of corneal opacity (p<0.000) was notified from the base line. Conclusion: Anterior lamellarmarginal z-plasty combined with transverse tarsotomy seems to have promising surgical outcome forthe correction of trichiasis and cicatricial entropion secondary to cicatricial trachoma.Keywords: Cicatricial ectropion, trichiasis, trachoma
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