Lateral tarsal strip versus Bick's procedure in correction of eyelid malposition

Objectives To compare the functional and anatomical outcomes of lateral tarsal strip (LTS) with Bick's procedure in treatment of eyelid malposition. Methods A retrospective, consecutive case series of patients who underwent LTS and Bick's procedure for all types of involutional lower eyelid malposition, at two centers between January 2012 and 2015. Statistical analyses of differences between groups were performed using the Fisher's exact test to compare non-continuous variables and Mann-Whitney U test for continuous variables. Results A total of 641 procedures (557 LTS and 84 Bick's) were performed on 504 patients (137 bilateral) by 7 consultants and their trainees. The study cohort included 286 males and 218 females. The mean age was 76.2 years (median 78). The mean follow-up was 13.07 months (median 7, range 0.5-58 months). The indications for surgery included ectropion (43.2%), entropion (39.9%), eyelid laxity (12.3%), floppy eyelid syndrome (2.7%), and others (1.9%). At last follow-up, the LTS group achieved 89.1% anatomical success (total + partial correction) compared to 100% in Bick's group (P < 0.001). Functional improvement was 82% and 95% in LTS and Bick's groups, respectively (P = 0.002). Consultants and trainee doctors achieved comparable outcomes within each group. Complications were relatively minor with no major long-term sequelae, nor any statistically significant difference between the two groups in terms of frequency of adverse events (16.9% vs 14.2%, P = 0.929). The reoperation rate was 9% in the LTS group during the study period, compared to none in the Bick's group (P = 0.001). Conclusions This study compares the outcomes of the largest reported cohort of eyelid malposition surgery analyzing the two different techniques for lid margin shortening. Bick's procedure achieved statistically significant better anatomical and functional outcomes compared to LTS although the samples were unequal and not randomized.