I thank Drs Kamal and Kumar for their interest in our recently published article. I am pleased to learn that they also found our surgical technique useful in correcting lid margin deformity, lid retraction, and lagophthalmos. Although the proposed surgery starts from lamellar division of the involved eyelid at the grey line and ends with posterior repositioning of the anterior lamella, our splitting of anterior and posterior lamella does not reach the level that they stated, that is, just short of superior fornix. As a matter of fact, ours only reaches the level that is sufficient to allow the anterior lamella to be recessed from the tarsal margin, that is, approximately 3 to 5 mm. They found it beneficial to pass 3 mattress sutures from the conjunctiva toward the skin, presumably in a manner similar to the Quickert procedure, which is known to prevent retraction of the posterior lamella and to correct entropion. They also performed the recession of the Müller muscle to create slight ptosis and to correct retraction as well as lagophthalmos. Notwithstanding the fact these steps have their own merits, however, we did not do so and have not noted such a shortcoming in our patients. We suspect that our patients may have different underlying causes from theirs because the main pathologic features reside at the lid margin, exhibiting keratinization, distichiasis, scarring, and contour deficit, instead of entropion or retraction. Because topical steroids had been used before the lid margin reconstruction in most patients, the main reason leading to improvement of all persistent corneal epithelial defects more likely is the result of the correction of the aforementioned lid margin deficits, but not topical steroids.

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Jan 12, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Reply

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