Comparison of three surgical procedures of differing complexity in the correction of trachomatous upper lid...

To compare the efficacy of three common surgical procedures of increasing complexity in the correction of trachomatous entropion.

In a prospective study, lids with moderate or severe (without lid gap) trachomatous entropion were randomly allocated to undergo either terminal tarsal rotation (I, n = 30), tarsal rotation with tarso-conjunctival advancement (II, n = 30), or anterior lamellar repositioning with lid margin split and wedge resection of tarsus (III, n = 30). The procedures were compared for improvement of symptoms, duration of surgery, cosmesis, rate and type of complications, anatomical correction, failure and recurrence. One-way and repeated-measure ANOVA, Chi-square and Fisher's exact tests were used.

The study included 90 eyes of 77 patients (age range: 30-85 years). Symptomatic improvement was comparable after each procedure (p > 0.05). Procedure I, the simplest in technique, took significantly less time (p < 0.001). The three procedures were comparable in achieving cosmesis (p = 1.0), anatomical correction (p = 0.35), and rate of complications (p = 0.43). Failure of surgery was seen in two lids (procedure II), and recurrence in one lid (procedure III).

In developing countries, where manpower and other resources are limited and patient-load high, ophthalmic surgeons should choose a procedure that is simple, quick and effective. This study suggests that terminal tarsal rotation after transverse tarsotomy should be the procedure of choice in the correction of moderate or severe (without lid gap) trachomatous entropion.