Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Lateral Fixation of the Lower Lid Tarsus for Lid Malpositions in Patients with Anticoagulant Therapy

Remky A., Kompa S., Redbrake C., Arend O.
Aachen University, Dept. of Ophthalmology

Purpose: Patients with coumarine therapy undergoing lid surgery have an increased risk of postoperative hematoma. Usually, coumarine therapy is discontinued for surgery and changed to intravenous heparin. Since two years we perform horizontal shortening of the tarsus by a lateral periostal fixation without changing the anticoagulant therapy.
Method: Eleven consecutive patients in the age of 72 - 90 with entropion (n = 4) or ectropion (n = 7) underwent surgery without discontinuing coumarine. First, the lower lid tarsus is cut at the lateral angle. Then, the tarsus is transposed laterally by a subcutaneous tunnel and a second incision at the temporal superior margin of the orbit and finally fixed at the periost by non-resorbing sutures
Results: In all eyes lid position was sufficient. Postoperatively, there was no relevant bleeding or hematoma. One eye having a strong occlusive pressure dressing got an acute angle closure situation with IOP elevation which could be controlled by systemic carboanhydrase inhibitors.
Conclusions: Lateral periostal fixation of the tarsus is an efficient procedure in lid malpositions. Since the tarsus wound is transposed laterally to the orbital margins over the canthus, the postoperative risk of retrobulbar hematoma, particularly increased for patients with coumarine therapy, is minimized.

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