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LETTERS TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 5  |  Page : 726-727

Response to comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision


1 Department of Orbit and Oculoplasty, Indira Gandhi Eye Hospital, Lucknow, Uttar Pradesh, India; Department of Corneo Plastics, Queen Victoria Hospital, East Grinstead, Surrey, United Kingdom
2 Department of Corneo Plastics, Queen Victoria Hospital, East Grinstead; Department of Ophthalmology, Frimley Park Hospital, Surrey, United Kingdom
3 Department of Corneo Plastics, Queen Victoria Hospital, East Grinstead, Surrey, United Kingdom

Date of Web Publication20-Apr-2018

Correspondence Address:
Dr. Nidhi Pandey
Indira Gandhi Eye Hospital, 1, BN Road, Qaiserbagh, Lucknow - 226 001, Uttar Pradesh

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_384_18

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How to cite this article:
Pandey N, Jayaprakasam A, Feldman I, Malhotra R. Response to comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision. Indian J Ophthalmol 2018;66:726-7

How to cite this URL:
Pandey N, Jayaprakasam A, Feldman I, Malhotra R. Response to comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision. Indian J Ophthalmol [serial online] 2018 [cited 2024 Mar 29];66:726-7. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2018/66/5/726/230676



Sir,

We thank the authors [1] for taking the time to read our paper [2] and for their valuable observations. The authors suggest a skin-crease approach which improves navigation to the lid margin. We would agree that for inexperienced surgeons, a combined approach improves accuracy. However, this technique is an option for more experienced surgeons interested in avoiding a skin incision. In our experience, accurate dissection at the lid margin can only be initiated with accurate placement of a lid margin incision. Approaching the lid margin purely through a skin crease leads to inadvertent exit through the skin or tarsus. With more experience, once past the lid margin, lamella dissection can be easily continued purely through a lid margin approach, thus avoiding a skin-crease incision. This approach is mainly indicated for cicatricial margin entropion. In such cicatricial cases, we would question the rationale for performing concurrent blepharoplasty as mild/moderate dermatochalasis would have no consequence to the outcome of correcting cicatricial margin malposition. This approach is obviously inappropriate for cases with severe dermatochalasis, and we specifically excluded cases from this series who required a concurrent blepharoplasty. We agree that the case with dermatochalasis in your report would perhaps benefit from a small concurrent blepharoplasty, and therefore, a skin-crease incision would provide further exposure.[3],[4] A skin-crease reformation, if required, is not necessarily an indication for a skin-crease incision. This can easily be performed without a skin-crease incision in a “closed” manner by simply passing double-armed sutures from the aponeurosis through to the skin crease.

We presented our series purely to remind readers that septum release and levator recession can be performed through a grey - line approach, where a blepharoplasty is not planned.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gawdat TI, Diab MM. Comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision. Indian J Ophthalmol 2018;66:725-6.  Back to cited text no. 1
  [Full text]  
2.
Pandey N, Jayaprakasam A, Feldman I, Malhotra R. Upper eyelid levator-recession and anterior lamella repositioning through the grey-line: Avoiding a skin-crease incision. Indian J Ophthalmol 2018;66:273-7.  Back to cited text no. 2
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3.
Aghai GH, Gordiz A, Falavarjani KG, Kashkouli MB. Anterior lamellar recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos. Eye (Lond) 2016;30:627-31.  Back to cited text no. 3
[PUBMED]    
4.
Bi YL, Zhou Q, Xu W, Rong A. Anterior lamellar repositioning with complete lid split: A modified method for treating upper eyelids trichiasis in Asian patients. J Plast Reconstr Aesthet Surg 2009;62:1395-402.  Back to cited text no. 4
[PUBMED]    




 

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