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

Authors

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

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 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

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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Published

2012-06-01

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