Single-Staged Surgical Correction of Eyelid Sequelae Along With Lid Margin Mucous Membrane Grafting in Stevens–Johnson Syndrome and Other Cicatricial Ocular Surface Diseases

Abstract

The purpose of this study was to study the outcome of single-staged entropion surgery along with lid margin mucous membrane grafting for cicatrizing ocular surface disease.Methods: Retrospective review of medical records of patients who underwent single-staged surgical correction of cicatricial entropion along with lid margin mucous membrane grafting for lid margin keratinization.Results: Twenty-six eyes of 19 patients were studied. The mean age of patients was 42.5 years (standard deviation, SD-17.67), of which 7 patients were male and 12 were female. The most common disorder was Stevens-Johnson syndrome (SJS) sequelae (83.33%, n = 20), followed by mucous membrane pemphigoid (n = 4, 16.67%). The most common eyelid changes observed were cicatricial entropion in all 26 eyes (100%, n = 26), followed by trichiasis in 13 eyes (50%, n = 13). Lid margin keratinization was noted in all eyes. Postoperative improvement in corneal surface staining was noted in 70% of the patients (n = 13), no change in 20% of the patients (n = 4), and worsening of corneal surface staining in 10% of the patients (n = 2). Postoperative visual acuity improvement was noted in 50% of the eyes (n = 13), no improvement in 39% of the eyes (n = 10), and vision worsened in 12% of the eyes (n = 3). An entropion recurrence rate of 25% (n = 6) was observed over an average 10-month follow-up, whereas 75% (n = 20) reported no recurrence.Conclusions: Single-staged correction of eyelid cicatricial entropion with a lid margin mucous membrane graft (MMG) has promising outcomes in ocular surface diseases. It can decrease the need for multiple surgeries and provide symptomatic relief in patients with chronic cicatricial surface changes.

Clinical Evaluation of Changes in Ocular Surface Integrity after Upper Eye Lid Entropion Surgery

“…In consistent with our results, Singh et al, they determined that among those who had a single-staged surgical correction for cicatricial entropion, along with lid margin mucous membrane grafting for lid margin keratinization, fifty percent of the eyes (n = 13) demonstrated improvement in postoperative visual acuity, 39 percent of the eyes (n = 10) revealed no improvement, as well twelve percent of the eyes (n = 3) experienced worsened vision [9].…”

Cicatricial Entropion in Chronic Cicatrizing Conjunctivitis: Potential Pathophysiologic Mechanisms and Long-Term Outcomes of a Modified Technique

“…4,11 Terminal tarsal rotation with MMG for trachomatous eyes achieves 90%-94% success rates and 83% in nontrachomatous eyes. 1,14 Tarsal rotation requires an incision through the tarsoconjunctiva and everts the marginal tarsus, thereby shortening the posterior lamella as MMG is a thin substitute for the whole tarsoconjunctiva. ALR+MMG was first described by Van Millingen 2 in 1887 and later used by Dortzbach and Callahan 8 , where the graft was sutured on the anterior bare tarsal area only.…”