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Updated: Jul 9, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Modified Hotz Operation Combined with Modified Medial Canthoplasty to Correct Congenital Lower Eyelid Epiblepharon in
Sixu Ren1, Bingtao Li1,2, Yu Wen3
1Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China.
Background:
Epiblepharon correction combined with epicanthoplasty is useful for the treatment of congenital lower eyelid epiblepharon (CE). To further refine this approach, we developed a modified medial canthoplasty (Mod-MC) involving removal of the medial canthus fibrous band (MCFB), combined with a modified Hotz procedure (Mod-Hotz). This study aimed to evaluate the efficacy of Mod-Hotz + Mod-MC in Chinese patients and to investigate the role of the MCFB in surgical outcomes.
Methods:
Patients diagnosed with CE were divided into two groups according to the surgical procedure performed: Mod-Hotz + Mod-MC and Mod-Hotz. Postoperative outcomes were compared between the two groups and analyzed statistically. The histopathological structure and ultrastructure of the MCFB were examined to analyze its correlation with surgical outcomes.
Results:
The cure rate was similar between the two groups in the 1month postoperative period. The recurrence rate in the Mod-Hotz + Mod-MC group was significantly lower than that in the Mod-Hotz group 12 months postoperatively. Ultrastructurally, the MCFB consisted of disorganized collagen and striated muscle with evidence of dissolution. Mitochondrial accumulation and vacuolation within muscle cells indicated significant structural and metabolic dysfunctions.
Conclusions:
The postoperative efficacy of Mod-Hotz + Mod-MC was more stable than Mod-Hotz alone. We suspected that the removal of the MCFB could eliminate abnormal fibrous tissue, minimize scar formation, and release abnormal vertical skin tension at the medial canthus, thereby helping maintain the stability of surgical effect.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
