Abstract

DO.12.04

Importance of the vectorial retractorsurgery for the correction of medial canthal insuficiency

Gündisch O., Pfeiffer M. J.
Augenklinik Herzog Carl Theodor, München

Objective: To avoid recurrence and persisting epiphora in involutive ectropion surgery cases it is very important to correct malpositions of the medial canthus. Therefor it is necessary to reposition the punctum in the threedimensional space according to the three vectors; into medial, into posterior and into cranial direction. We analyzed our ectropion cases between 2000-2007.
Methods: Additional to horizontal tightening by a lateral strip procedure we corrected the punctal eversion using a transconjunctival advancement of the retractor sheath and inverting sutures. The same suture also lifts the orbicularis layer, therefore increasing the inverting effect on the lidmargin.
The special feature of our surgical technique is that it corrects all three vectors (medial, posterior and cranial vector), which determines the position of the lidmargin in the threedimentional space. In complicated cases combined with secondary skinretraction and lidmargin-deformities, we used free skin-grafting and reshaping of the lidmargin.
Results: Between January 2000 and February 2007 we corrected 804 ectropion cases. Only 12% of the cases presented a simple horizontal laxity and could be treated with a lateral canthal procedure alone. The remaining 88% of our cases needed an additional medial retractor advancement in order to correct a medial fixation insufficiency. In 30% of the cases medial skin retraction was involved in the eversion and had to be corrected with a free skin grafting.
Conclusions: Simple procedures of horizontal shortening are only sufficient in 12% of the cases. Nearly 90% of the cases require an additional medial retractor advancement to obtain a correct punctum position. We found skin retraction in 1/3rd of the cases. Even minimal skin retraction below the punctum can be responsible for surgical failure and therefore must be corrected by skin grafting.

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