一沟一线法治疗难治性瘢痕性上睑内翻

瘢痕性睑内翻是由于结膜或睑板的瘢痕收缩、睑缘向内卷转所致。临床上多采用Hotz法治疗,效果比较理想。但对于一些经Hotz术后仍旧复发或在术中即发现矫正效果不理想的患者,我们采用“一沟一线”法Hotz加强术式治疗,效果满意。     

异体巩膜条睑板延长术治疗复发性瘢痕性睑内翻

目的：探讨异体巩膜条睑板延长术治疗复发性瘢痕性上睑内翻的手术疗效。方法：对27例(36只眼)复发性瘢痕性上睑内翻患者采用从睑板沟切断睑板的方法，在睑板铁损区嵌入异体巩膜条，延长睑板，松解瘢痕。结果：28只眼内翻矫正，8只眼复发，3只眼再次手术后矫正。结论：采用异体巩膜条睑板延长术治疗复发性瘢痕性眼睑内翻，手术方法简便，损伤小，可反复操作，疗效满意，异体巩膜易于获得及保存，是一种值得推广的手术方法。     

睑板部分切除联合脱细胞真皮植入矫正瘢痕性上睑内翻临床观察

目的 评估睑板部分切除联合脱细胞真皮植入矫正瘢痕性上睑内翻的临床疗效.方法 对严重眼化学伤或热烧伤致瘢痕性上睑内翻的病人11例(13只眼睑),均行睑板部分切除联合脱细胞真皮植入术.术后随访5～20个月(平均10个月).结果 11只眼睑内翻获得成功矫正.有2只眼睑内翻复发,再次手术后睑内翻获得成功矫正.荧光素染色试验显示术后所有患者角膜上皮缺损明显减少.术前泪膜破裂时间(BUT)为(4.46±1.20)s,术后3个月延长至(6.92±1.32)s,差异具有统计学意义(P＜0.01);术后泪液分泌量(Schirmer I试验)与术前相比较差异无统计学意义(P＞0.05).结论 用睑板部分切除联合脱细胞真皮植入术来治疗由眼部化学伤或热烧伤引起的伴有眼睑变形的瘢痕性上睑内翻是一种安全有效的方法.     

睑板全切术治疗重症睑内翻

目的探讨睑板全切术治疗重度睑内翻的方法。方法对732例（1175眼）重度睑内翻、Hotz术和“六三一”眼睑内翻法术后复发病人施行睑板全切术。结果732例（1175眼）睑内翻全部矫正。结论该手术后疗效确切，操作简便，器械简单，易于掌握，适宜县级医院及巡回医疗开展施行。     

睑内翻改良手术的设计与效果观察

目的探讨一种治疗上睑瘢痕性睑内翻的改良手术方法的效果。方法设计上睑瘢痕性睑内翻的改良手术,包括:上睑重睑术皮肤切口、睑板楔形切除、皮肤部分切除及自穹隆部球结膜进针的褥式缝合线等。临床应用442例619眼,随访6个月,观察其矫正效果。结果本组442例(619眼)中,3例(3眼)3个月后仍有2~3根睫毛方向不正,接触眼球,经睫毛电解后痊愈。余439例(616眼)获得较为满意的治疗效果及美容效果。结论作者设计的上睑内翻改良手术,融合了传统的睑内翻矫正术及现代美容手术的优点,效果良好。     

倒睫Hotz矫正术切除睑板宽度的规范

Hotz术适用于矫正上睑多种倒睫.运用睑缘厚:睑板厚=2:1的规律,距睑缘3.5～4mm,1刀切软组织达睑板.沿睑缘侧皮肤切口垂直切睑板,切除睑板楔形条的睑板面宽规以1.8倍上睑缘宽,是这样切出的睑板槽沟夹角为68～78°,则倒睫回到倾斜110°最佳正常位置.临床实践与动物实验结果一致,4年复发率仅3%.Hotz术旧作法随手切除睑板宽度所矫正的倒睫4年复发率达64%,二者存在高度显著性差异.     

一种新的上睑内翻矫正术

内翻倒睫矫正手术名目不少,但总起来说,手术之矫正离不开睑板。常见的有睑板切断、睑板切除及Hotz术(从皮肤面进行的睑板楔形切除术)。睑板切断手术简便,但每易复发,睑板切除与Hotz术效果较好,但操作较为复杂。近年来,Brandt在西德眼科临床月刊发表了一种矫正上睑内翻的新颖手术,原先作者     

两种术式治疗重度上睑瘢痕性睑内翻的疗效比较

目的：比较显微镜下Hotz法联合睑缘切开皮瓣转位术和单纯Hotz法治疗重度上睑瘢痕性睑内翻的临床效果。

方法：回顾性分析2017-07/2019-07在我院接受上睑内翻倒睫矫正术的患者60例84眼,试验组32例42眼采用显微镜下Hotz法联合睑缘切开皮瓣转位术,对照组28例42眼采用单纯Hotz法。术后随访观察至12mo, 记录患者主观症状、睑缘位置、睫毛外翻情况及满意度。

结果：试验组单眼平均手术时间长于对照组(40.8±2.57min vs 28.5±2.64min,P<0.01)。术后1、12mo,试验组治愈率分别为100%、95%,对照组治愈率分别为95%、76%,术后12mo试验组治愈率优于对照组(P=0.013)。 术后1mo两组患者满意度无差异(Z=1.1825,P=0.2371),术后12mo试验组患者满意度高于对照组(Z=3.7346,P<0.01)。

结论：对于重度上睑瘢痕性睑内翻,显微镜下Hotz法联合睑缘切开皮瓣转位术虽手术时间长于单纯Hotz法,但其远期疗效优于单纯Hotz法,术后12mo患者满意度较高。     

自体皮片移植手术治疗上睑瘢痕性睑内翻

目的 探讨自体皮片移植治疗上睑瘢痕性睑内翻的临床效果.方法 对17例(23只眼)瘢痕性上睑内翻,采用自体皮片游离移植进行矫治.结果 术后随访6～15个月,术后反应轻微,外观矫治满意,睑缘睫毛恢复正常解剖位置.部分患者视力在术后得到提高.眼部主观感觉亦得到了改善.结论 自体皮片移植治疗作为一种手术方法,在矫治重度上睑瘢痕性睑内翻的应用中疗效满意.     

退行性睑内翻手术治疗的心得体会

目的 探讨退行性睑内翻手术治疗的临床疗效.方法 下睑睑板前面的眼轮匝肌束切除,眼轮匝肌切除后解除睑缘向上卷缩,使眼睑轮匝肌肌力减弱,再分离切除部分多余的皮肤,行睫毛根部皮下组织与睑板的缝合.结果 43只患眼中40眼下睑内翻得到较好的矫正,达到治愈标准,用力闭眼时均未出现内翻,有3眼达到好转标准,用力闭眼时内侧出现轻度内翻,无未愈者,随访观察2个月～2年,未出现复发.结论 我科采用此方法,即治疗皮肤松弛引起的内翻,又有一定美容作用.与其它退行性睑内翻方法比较,损伤小,操作简单,手术时间短,患者痛苦小,术后瘢痕小,恢复快,安全有效.     

老年低张性下睑内翻的手术治疗方法

目的 探讨低张性下睑内翻的有效治疗方法。方法对11例（16眼）低张性下睑内翻施行眼轮匝肌缩短,睑板楔形切除,下睑缩肌腱膜加固,皮肤除皱手术。结果全部术后睑内翻消失,无外翻,美容效果良好。术后随访1～5年,无复发者。结论对老年低张性下睑内翻的患者采用眼轮匝缩短、睑板楔形切除、下睑缩肌腱膜加固及皮肤除皱治疗,可有效矫正内翻,改善容貌,又能避免睑外翻。     

儿童先天性下睑内翻的治疗

目的 探讨儿童先天性下睑内翻的不同发病机制及对症治疗的效果.方法 102例（204眼）儿童先天性下睑内翻,年龄1岁5个月～15岁.对不同的临床表现采用不同的手术方法矫正.结果 对于下睑内翻轻度,眼球上下转动睫毛的位置不改变者,行单纯下睑穹隆皮肤3对缝线法6例（12眼）;下睑内翻轻度,向前方注视睫毛不接触眼球,眼球向下转动时睫毛接触眼球者,采用下直肌鞘离断术7例（14眼）;睑内翻中度或重度,眼球向下转动时加重者,采用下直肌鞘纤维离断联合缝线法45例（90眼）;下睑内翻中度或重度,眼球上下运动睫毛位置无改变者,采用下睑皮肤和下眼轮匝部分切除的切开法（Hotz法）42例（84眼）.单纯内眦赘皮矫正术2例（4眼）.术后随诊3个月～1年,97.05％的患眼下睑内翻得到完全矫正,2.95％的患眼内眦部有倒睫.结论 儿童先天性下睑内翻根据其临床不同的表现,采取个性化的治疗,方能达到最佳的效果.     

Simple Tarsectomy: Its Indications and Technique

The manner in which tarsectomy influences the trachomatous process is analyzed with particular attention to the mechanical factor of relieving the lid pressure. Corneal involvement and beginning entropion are accepted as indications for this procedure. In the technique of simple tarsectomy an incision through skin and orbicularis is favored. A new method of intermarginal tarsectomy with transplantation of mucosa is proposed for cases of advanced trachoma with misplacement of cilia.     

Surgical treatment of entropium senile (author's transl)]

The authors report on a modification of the entropion surgery of Celsus-Hotz which was successfully carried out in 87 patients with entropion senile from 1969 to 1976. After excision of an about 5 mm wide crescentshaped dermal tissue of the lower eyelid about 3 mm down the margin the muscle fibres of the M. orbicularis near the margin are resected. Before suturing the skin 3-6 stitches of Hotz are done to reduce the tarsus. The advantages of this technique are the safe therapeutical effect, the cosmetical effect and the easy correction of this operation in case of a failure.     

睑缘切开带蒂轮匝肌瓣充填术治疗严重上睑内翻倒睫

目的 评价睑缘切开带蒂轮匝肌以填术治疗严重上睑内翻倒睫的临床疗效。方法 对我院门诊诊断严重上睑内翻倒睫病人１１１例１９７眼行睑缘灰带切开带蒂轮匝肌,瓣充填术;术后随访,观察术后２ｗｋ、６、１２及３６ｍｏ的疗效。结果 术后２ｗｋ带蒂轮匝肌瓣全部成活,睑缘上以长入肌瓣表面;术后６ｍｏ无复发病例,失记２例（３眼）;术后１２ｍｏ,复发２例（２眼）,失访９例（１７眼）,复发率１．１％,术后３６ｍｏ,复发５例     

Wedge resection of the tarsal plate combined with the modified Hotz procedure for correction of involutional lower eyelid entropion

Objectives

To investigate the outcomes for correction of involutional lower eyelid entropion by wedge resection of the tarsus combined with the modified Hotz procedure.

退行性下睑内翻眼轮匝肌缩短矫正术欠矫原因及修补△

目的 分析退行性下睑内翻眼轮匝肌缩短矫正术欠矫原因,评估再次手术修补的效果。方法 收集2008~2017年我院退行性眼睑内翻行眼轮匝肌缩短矫正手术欠矫病例27例(27眼)。分析欠矫原因,并根据其原因选择相应手术方式,观察再次矫正的手术效果。结果 退行性眼睑内翻原因和修补方式为:下睑缩肌断裂未修补15例,给予下睑缩肌修复;水平松弛未矫正7例,给予外眦韧带缩短手术;5例同时存在下睑缩肌断裂和水平松弛,行下睑缩肌修复联合外眦韧带缩短手术。再次手术随访时间内[(18.74±12.11)个月]所有患者症状消失,眼睑位置正常。结论 退行性眼睑内翻眼轮匝肌缩短手术欠矫的原因为手术方式选择不完全正确,眼睑退行性改变因素未得到充分矫正。发生欠矫时,应仔细分析其原因,选择合适的手术方式,仍可以获得良好的矫正效果。     

Clinical study of single-suture inferior retractor repair for involutional entropion

PURPOSE: To evaluate the clinical efficacy of a simplified single-suture inferior retractor repair technique for involutional entropion. METHODS: A retrospective study of 20 patients (26 eyelids), followed for 6 months at our hospital, who showed no severe horizontal lid laxity were operated on for involutional entropion. After subciliary incision, the inferior retractor was identified and repaired by reattaching the superior edge of the inferior retractor to the inferior edge of the lower tarsus by a single suture using 5-0 prolene. RESULTS: 26 eyelids of 20 patients (80.8%) were treated successfully without recurrence. Complications were seen in 5 eyelids, 2 were overcorrections and 3 were recurrences of entropion. Recurred cases were reoperated on and showed good postoperative results after the second surgery. CONCLUSIONS: The simplified single-suture inferior retractor repair had good results in patients with involutional entropion without severe horizontal lid laxity. Moreover, this procedure had a short operation and recovery time. In unilateral cases, we could achieve more symmetric appearance when compared with bilateral surgeries.     

Cicatricial entropion associated with chronic dipivefrin application

PURPOSE: To report patients who presented to the oculoplastics department for repair of cicatrical entropion after topical use of dipivefrin. To discuss the possible mechanisms of action and highlight the potential detrimental effects of dipivefrin on palpebral conjunctiva. METHODS: Retrospective consecutive noncomparative case series. Nine eyes from 6 patients, 74 years to 90 years of age, referred by ophthalmologists for repair of cicatricial entropion after at least 2 years of twice-a-day application of dipivefrin. RESULTS: After cessation of topical dipivefrin application and successful surgical repair of entropion, no recurrence of signs or symptoms has been reported. Moderate lymphocytic infiltration of the substantia propria of the conjunctiva of both upper and lower lid specimens was present, as was scarring and keratinization of the epithelium. CONCLUSIONS: Cicatrization in the substantia propria of the conjunctiva by excessive lymphocytic infiltration after topically administered antiglaucoma drugs including dipivefrin is a possible mechanism of action for entropion.