Retrospective Comparative Analysis of Surgical Efficacy: Jones Procedure versus Combined Jones-Hotz Technique in the Management of Involutional Entropion

Abstract

          Background: Involutional entropion represents a prevalent ophthalmic disorder in Asian populations, particularly amid the demographic transition toward aging societies. The condition significantly impairs patients' quality of life through ocular discomfort and visual disturbances. Age-related attenuation and laxity of the capsulopalpebral fascia (CPF) fundamentally limits the efficacy of isolated Jones retractor plication, necessitating supplementary surgical interventions. This study evaluates the comparative effectiveness of the Jones procedure alone versus a combined Jones-Hotz approach in entropion correction.

            Methods: A retrospective comparative cohort study was conducted examining patients who underwent lower eyelid entropion repair between January 2015 and December 2023. All procedures were performed by a single surgeon. The study comprised 88 eyelids divided into two groups: Group A (n=47) underwent Jones retractor plication exclusively, while Group B (n=41) received combined Jones retractor plication with modified Hotz procedure. Inclusion criteria specified involutional entropion without horizontal eyelid laxity and minimum six-month follow-up. Primary outcome measure was recurrence rate; secondary outcome was operative duration.

            Results: Demographic characteristics demonstrated no statistically significant intergroup differences (mean age 70.6 years, range 61-92; male predominance 72%). Complete correction of ciliary orientation was achieved in all patients with universal patient satisfaction. Group A demonstrated a recurrence rate of 19.15% (9/47 cases) with mean operative time of 30.6 minutes. Group B exhibited significantly superior outcomes with a recurrence rate of 4.65% (2/41 cases; p<0.05, Fisher's exact test) and mean operative time of 41.4 minutes. The odds ratio of 0.21 indicated Group B patients had approximately 4.76-fold lower recurrence odds compared to Group A. One case of mild, self-resolving ectropion occurred in Group B.

            Conclusions: The combined Jones-Hotz procedure demonstrates statistically significant superiority over isolated Jones retractor plication in treating involutional entropion without horizontal laxity, reducing recurrence rates from 19% to 5%. The incremental operative time of 10.8 minutes represents a clinically acceptable trade-off for substantially improved long-term outcomes. This combined approach addresses multiple pathophysiological factors—specifically CPF dehiscence and preseptal orbicularis override—thereby providing comprehensive anatomical correction. These findings support adoption of the combined technique as the preferred surgical intervention for involutional entropion in appropriate candidates.