Efficacy of lateral eyelid-block excision with canthoplasty and full-thickness skin grafting in lower eyelid cicatricial ectropion.

PURPOSE: To report on the outcomes of our preferred surgical technique for the correction of lower eyelid cicatricial ectropion METHODS: We conducted a retrospective, nonrandomized, interventional analysis of a consecutive case series of patients with cicatricial lower lid ectropion treated with adhesiolysis, lateral eyelid-block excision with canthoplasty and full-thickness skin grafting. Donor sites included the ipsi- or contralateral upper eyelid and pre- or retroauricular skin. All patients were treated by one of our oculoplastic surgeons in the period from January 2005 to January 2017 in the Rotterdam Eye Hospital/Focus Clinic Rotterdam. We assessed postoperative lower eyelid apposition, the occurrence of intra- and postoperative complications and the reoperation rate. RESULTS: We included 38 eyelids of 32 patients, of whom 17 were male and 15 were female. The minimal postoperative follow-up was 3 months. A total of 27 of 38 eyelids showed good postoperative apposition. Skin graft donor sites were the ipsi- or contralateral upper eyelid (47% and 16%, respectively) and the pre- or retroauricular skin (26% and 11%, respectively). No intraoperative complications occurred, but one patient developed a transient allergic contact dermatitis in the early postoperative phase. Two of 38 eyelids (two of 32 patients) required another surgical intervention (block excision) for residual or recurrent ectropion, with favourable outcomes. There was 100% viability of the skin grafts. CONCLUSION: Repair of lower eyelid ectropion with lateral block excision, canthoplasty and full-thickness skin grafting is an effective procedure with minimal donor site morbidity, excellent graft survival rates and a low reoperation rate.

Toric intraocular lenses for correction of astigmatism in keratoconus and after corneal surgery.

PURPOSE: To describe the results of cataract extraction with toric intraocular lens (IOL) implantation in patients with preexisting astigmatism from three corneal conditions (keratoconus, postkeratoplasty, and postpterygium surgery). METHODS: Cataract patients with topographically stable, fairly regular (although sometimes very high) corneal astigmatism underwent phacoemulsification with implantation of a toric IOL (Zeiss AT TORBI 709, Alcon Acrysof IQ toric SN6AT, AMO Tecnis ZCT). Postoperative astigmatism and refractive outcomes, as well as visual acuities, vector reduction, and complications were recorded for all eyes. RESULTS: This study evaluated 17 eyes of 16 patients with a mean age of 60 years at the time of surgery. Mean follow-up in this study was 12 months. The corrected distance Snellen visual acuity (with spectacles or contact lenses) 12 months postoperatively was 20/32 or better in 82% of eyes. The mean corneal astigmatism was 6.7 diopters (D) preoperatively, and 1.5 D of refractive cylinder at 1-year follow-up. No vision-compromising intra- or postoperative complications occurred and decentration or off-axis alignment of toric IOLs were not observed. CONCLUSION: Phacoemulsification with toric IOL implantation was a safe and effective procedure in the three mentioned corneal conditions. Patient selection, counseling, and IOL placement with optimal astigmatism correction are crucial.