羊膜移植结膜囊成形术的疗效观察

目的探讨羊膜移植结膜囊成形术中的疗效。方法36例（36眼）结膜囊成形术,包括16眼结膜缺损,行单纯羊膜移植术;8眼睑球粘连涉及角膜或角膜有大量新生血管,行羊膜移植联合板层角膜移植术;12眼行羊膜移植联合结膜穹隆成形。术后随访6～12个月。结果无1例感染。术后10d,移植的羊膜透明,缝合处结膜向羊膜上爬行;术后1个月新生的结膜上皮完全覆盖移植区。36眼治愈14眼,好转19眼,无效3眼。结论羊膜移植是修补结膜囊的一种有效方法。     

羟基磷灰石眼座植入和结膜囊成形术矫治眼窝畸形

目的探讨眼窝凹陷合并结膜囊狭窄行羟基磷灰石眼座植入和／或结膜囊成形术的手术方案和疗效。方法　比较６１例６１只眼分别行羟基磷灰石眼座植入联合结膜囊成形术（术式Ｉ）,和二期结膜囊成形术（术式Ⅱ）的术后井发症和疗效。结果随访４月～３年,１５例术式Ⅰ患者术后反应重,并出现１例ＨＡ眼座感染,３例移植物部分坏死ＨＡ眼座暴露,３例睑缘融合裂开。４６例术式Ⅱ患者术后反应轻,并发症少,仅有５例睑缘融合部分裂开,１例眼模脱出未及时就诊而再次手术。结论眼窝凹陷合并结膜囊狭窄应首先施行羟基磷灰石眼座植入术,二期行结膜囊成形术,减少严重井发症的发生,提高手术效果。     

下睑成形改良术治疗不同类型睑袋的疗效

目的：探讨改进后的下睑成形术治疗不同类型睑袋的疗效。
　　方法：选取2010-05/2015-05间我院实施下睑成形术的患者67例67眼,按照睑袋情况进行分型,并采取不同改进术式：A组：单纯脂肪膨出型12眼采用经结膜切口入路法;B组：皮肤或(和)轮匝肌松弛型19眼,采用经皮肤入路法,需在手术过程中切除下睑皮肤、眼轮匝肌;C组：皮肤肌层松弛合并眶脂膨出型13眼,采用经皮肤入路法,术中切除眶隔脂肪、皮肤及眼轮匝肌;D组：混合型23眼,采用经皮肤入路法,需在手术中切除眶隔脂肪、皮肤及眼轮匝肌。
　　结果：术后5 d拆线,术后随访3~6 lo。四组患者手术效果优良率分别为100%、95%、100%及96%,差异无统计学意义(P>0.05)。患者下睑外观平坦,眶脂膨出消退,有1眼出现轻度睑外翻,2眼眶下缘凹陷以及4眼切口对合欠佳,术后2 lo均自行恢复。未出现斜视复视、下睑退缩等严重并发症。四组患者术后并发症发生率分别为8%、11%、8%及13%,差异无统计学意义( P>0.05)。
　　结论：改进后的下睑成形术治疗不同类型睑袋术后效果满意。     

封闭结膜和Tenon囊间隙联合羊膜移植及纤维蛋白胶治疗睑球粘连的疗效观察

目的　研究封闭结膜和Tenon囊间隙技术联合羊膜移植及纤维蛋白胶治疗睑球粘连的临床疗效。方法　对31例（34眼）睑球粘连患者进行睑球粘连松解并切除异常纤维血管组织后，采用连续缝线封闭结膜和Tenon囊间隙技术联合羊膜移植进行治疗，术中辅以纤维蛋白胶固定羊膜。对结膜不足的重度睑球粘连病例使用自体唇黏膜移植封闭间隙。观察眼表重建效果、眼表炎症、眼球活动度、视力、移植材料情况及并发症等。结果　术后12个月34眼中完全成功25眼、部分成功6眼、失败3眼。术后疗效和术前睑球粘连的长度、宽度以及炎症活动度均有相关性（均为P＜0.05）。术后眼球活动度及炎症活动度得到显著改善（P＜0.05），6眼视力提高。结论　封闭结膜和Tenon囊间隙联合羊膜移植及纤维蛋白胶治疗睑球粘连疗效显著，其中使用连续缝线封闭结膜和Tenon囊技术是手术治疗睑球粘连的一个重要步骤。     

带蒂眼轮匝肌翻转术治疗严重下睑内翻

目的评价带蒂眼轮匝肌转位术治疗严重下睑睑内翻的临床疗效。方法对我院门诊诊断严重下睑睑内翻106例（146眼）行带蒂眼轮匝肌翻转术。观察术后1周、3个月、12个月的疗效。结果术后12个月除失访14例（16眼）情况不明外,无复发者。结论带蒂眼轮匝肌转位术治疗严重下睑内翻具有较好疗效。     

心包移植在结膜囊成形术中的应用

目的探讨保存人心包移植治疗结膜囊狭窄的临床效果及安全性。方法眼球摘除术后伴结膜囊狭窄综合征26例（26眼）,行心包移植结膜囊成形术,术后随访观察3—12个月,平均8个月。结果24眼在术后30—60d移植的心包被结膜覆盖,感染1例,结膜囊狭窄1例。结论保存心包移植治疗结膜囊狭窄操作简单,疗效良好。     

异种(牛)脱细胞真皮在结膜囊成形术中的临床应用

目的探讨采用异种(牛)脱细胞真皮作为移植材料行结膜囊成形术的安全性及效果。方法 9例(9眼)眼内容摘出术后结膜囊狭窄患者,行义眼座植入联合结膜囊成形术,术中应用Medpor义眼座作为眼窝填充材料、异种(牛)脱细胞真皮作为结膜生长支架移植材料。义眼座植入后行结膜囊成形术,将异种脱细胞真皮修剪后移植于结膜缺损处,放入眼模,缝合睑缘,术后抗炎治疗3个月拆除睑缘缝线。随访观察6～18个月,平均8个月。结果 9例患者术后均无明显排斥反应,无义眼座暴露;植片色泽逐渐红润,无坏死、脱落及明显收缩,结膜上皮爬行并覆盖植片表面。术后3个月植片近似正常结膜外观,结膜囊成形好,配戴义眼片后患眼外观良好,不滑脱。9例患者中8例效果良好,1例一般。结论采用异种(牛)脱细胞真皮作为结膜囊成形移植材料,手术操作方便,异种脱细胞真皮组织相容性好,结膜囊成形效果满意。     

老年性下睑睑内翻不同术式的效果观察

目的比较两种不同术式治疗老年性下睑内翻的临床疗效。方法46例（57眼）老年性下睑内翻随机分为两组。A组22例（28眼）行眼轮匝肌缩短联合睑板切除术;B组24例（29眼）行改良式皮肤眼轮匝肌切除术。结果随访18个月,术后1周及6个月时,A、B两组均获良好疗效,术后12个月及18个月时,甲组效果优于B组,两组结果差异有统计学意义（P〈0．05）。结论眼轮匝肌缩短联合睑板切除术较改良式皮肤眼轮匝肌切除术治疗老年性睑内翻远期效果好。     

外伤致结膜囊狭窄129例临床分析

目的探讨外伤所致结膜囊狭窄的手术治疗方法及效果。方法 129例（129眼）因严重眼外伤、重症化学烧伤、热烫伤而致结膜囊狭窄者,先行义眼座植入,6个月后再行结膜囊成形术。结果 83例（64.34%）疗效较好,41例（31.78%）疗效一般,5例（3.88%）疗效较差。主要并发症有义眼座暴露1例,结膜囊再狭窄4例,残留上眶区凹陷3例,睑缘融合裂开3例,上睑下垂2例。结论对外伤所致结膜囊狭窄患者先行义眼座二期植入,6个月后再行结膜囊成形术,效果良好。     

义眼座植入同期利用羊膜移植结膜囊重建术的临床观察

目的 探讨结膜囊狭窄患者义眼座植入同期利用羊膜移植重建结膜囊的临床效果。方法 对23例结膜囊狭窄患者行义眼座植入同时行结膜囊重建术。术中下穹隆采用埋线法固定在眶下壁骨膜,保存羊膜移植于结膜缺损区,上下睑缘褥式缝合。每周打开眼睑并用荧光素试纸染色,观察结膜上皮生长情况。术后2个月拆除上下眼睑缝线,定制合适的义眼。结果 术后第4周20只术眼羊膜表面全部被结膜上皮覆盖,其余3只术眼发生羊膜融解,结膜上皮未愈。术后2个月4只Ⅰ度结膜囊狭窄患眼全部治愈;10只Ⅱ度结膜囊狭窄患眼中8只治愈,2只好转;9只Ⅲ度结膜囊狭窄患眼中3只术眼痊愈、3只术眼好转,余3只术眼无效,其中1只术眼半年后重新行结膜囊成形术。完成治疗的21例患者无义眼座暴露、感染及睑球粘连等并发症,对术后眼座的活动度和外观比较满意。结论 对于Ⅰ和Ⅱ度的结膜囊狭窄采用保存羊膜移植同期行眼座植入术是安全可行的。对于Ⅲ度结膜囊狭窄采用保存羊膜移植疗效欠佳。（     

眼轮匝肌肌皮瓣与“风筝”皮瓣联合重睑成形术修复眼睑肿块切除后眼睑前层缺损的效果对比

目的对比分析眼轮匝肌肌皮瓣与"风筝"皮瓣联合重睑成形术修复眼睑肿块切除后眼睑前层缺损的临床效果。方法选择2018年3月至2019年9月到我院进行修复治疗的36例眼睑肿块切除后眼睑前层缺损患者为研究对象,根据其术式不同进行分组,A组(n=20)采用眼轮匝肌肌皮瓣联合重睑成形术进行修复治疗,B组(n=16)采用"风筝"皮瓣联合重睑成形术进行修复,比较两组术中出血量、手术时间、术后皮肤存活率以及患者满意度。结果A组术中出血量11.75±2.17ml、手术时间44.70±7.55min明显少于B组术中出血量17.69±2.89ml、手术时间54.19±6.68min(P<0.05)。两组皮瓣存活率100%,对比无明显的差异(P>0.05)。A组术后并发症发生率5%明显少于B组31.25%(P<0.05)。A组患者对术后外观满意度95.0%,较B组68.75%明显升高。结论眼轮匝肌肌皮瓣与"风筝"皮瓣联合重睑成形术均能够良好地修复眼睑肿块切除后皮肤缺损,皮瓣存活率高,但采用眼轮匝肌肌皮瓣联合重睑成形术术中出血量更少,术后患者满意度更高,值得推广应用。     

Eyelid kinematics following blepharoplasty.

PURPOSE: This study characterizes the effects of blepharoplasty on blink dynamics in subjects with dermatochalasis. The authors evaluate the hypothesis that orbicularis oculi removal and the consequent alterations in blink are potentially harmful consequences of blepharoplasty. METHODS: Sixteen patients were studied, before and after laser blepharoplasty, by a modified scleral search coil technique. Changes in lid position during blinks were recorded before surgery as well as 2 months, and 1 year postoperatively. Off-line analyses assessed blink down-phase amplitude, peak velocity, duration, and main sequence (peak velocity versus amplitude) relationships. RESULTS: Despite muscle resection, there was no significant compromise of mean blink down-phase amplitude, peak velocity, or main sequence following blepharoplasty. Mean blink duration was likewise unchanged at either follow-up session from the preoperative state. Our data show that upper lid blepharoplasty does not cause any lasting decrement in lid function in blinking. CONCLUSIONS: Blepharoplasty includes resection of a portion of the orbicularis oculi. It appears unlikely that the purposeful resection of preseptal portion of the orbicularis oculi that accompanies blepharoplasty is responsible for any functional complications such as dry eye.     

眼睑瘢痕畸形的手术治疗

目的探讨不同类型瘢痕性眼睑畸形的手术方式及治疗效果。方法瘢痕性眼睑畸形10例（15眼）,分别行瘢痕松解及游离皮瓣移植术4例（7眼）,瘢痕松解游离皮瓣移植同时行羊膜移植1例（1眼）,瘢痕松解联合“Z”字皮瓣转位2例（3眼）,瘢痕松解联合带蒂皮瓣转位1例（1眼）;瘢痕松解联合眼轮匝肌蒂皮瓣修复1例（1眼）,瘢痕松解联合睑板楔形切除联合双下眼睑成形术1例（2眼）。结果10例（15眼）手术后获得不同程度满意的外观和功能恢复。结论在眼睑瘢痕修复时,只要能使皮肤缺损和结膜囊完整性得到修复,瘢痕性眼睑畸形恢复眼睑功能及外观,效果良好。     

Upper eyelid island orbicularis oculi myocutaneous flap for periorbital reconstruction

PURPOSE: To describe the upper eyelid island orbicularis oculi myocutaneous flap, medially or laterally based, for reconstruction of periorbital defects. METHODS: During the past three years we have used the island orbicularis oculi myocutaneous flap in 62 patients with tumors of the periorbital area, with the following indications: (a) anterior lamellar defects of the medial aspect of the upper eyelid, when the peripheral arcade is intact; (b) up to 2/3 anterior lamellar lower eyelid defects; (c) inner and outer canthus defects; and (d) defects of the peripalpebral area (the lateral half of the eyebrow, bridge of the nose and suprazygomatic areas). RESULTS: The flap proved to be flexible, safe, relatively simple, and provided good functional and aesthetic results. Complications were minimal. CONCLUSIONS: The upper eyelid island orbicularis oculi myocutaneous flap may be a useful tool for periorbital reconstruction.     

老年性睑板腺功能障碍患者下睑内翻的两种术式疗效对比

目的　对比皮肤-眼轮匝肌瓣切除术和皮肌瓣联合外侧睑板楔形切除术矫正老年性睑板腺功能障碍患者下睑内翻的临床效果。方法　选取2016 年8月至2018年1月在南昌大学第一附属医院眼科确诊为下睑内翻的老年性睑板腺功能障碍患者40例（80眼）作为研究对象,根据手术方式不同分为两组,A组行皮肤-眼轮匝肌瓣切除术,B组行皮肌瓣联合外侧睑板楔形切除术。两组分别于术前和术后1周、1个月行睑缘评分、睑板腺挤压试验、睑板腺分泌功能试验、脂质分泌情况评分、泪液分泌试验、泪膜破裂时间、角膜荧光素染色、眼表症状及体征评分等,并作对比。结果　术后1个月与术前相比,除B组干涩症状外,其余A、B两组眼部症状均有明显好转,差异均有统计学意义（均为P＜0.05）;与B组相比,A组术后1个月时干涩、疼痛、异物感、灼烧感和流泪症状缓解情况更为明显,差异均有统计学意义（均为P＜0.05）。术后1个月,B组睑脂评分较术前升高,且较A组升高,差异均有统计学意义（均为P＜0.05）;其余睑板腺相关指标术后1周、1个月与术前相比差异均无统计学意义（均为P>0.05）。术后1个月,两组眼部OSDI评分、泪液分泌试验、角膜荧光素染色、泪膜破裂时间均较术前明显改善,差异均有统计学意义（均为P＜0.05）;与B组相比,A组角膜荧光素染色评分更低、泪膜破裂时间延长更显著,差异均有统计学意义（均为P＜0.05）。结论　对于老年性睑板腺功能障碍伴下睑内翻患者,皮肤-眼轮匝肌瓣切除术优于皮肌瓣联合外侧睑板楔形切除术。     

采用180°旋转皮瓣修复眼睑肿物切除术后眼睑皮肤缺损的临床研究

目的　探讨采用180°旋转皮瓣修复眼睑肿物切除术后眼睑皮肤缺损的安全性和有效性。方法　回顾性分析29例38眼采用180°旋转皮瓣修复眼睑肿物切除术后造成的眼睑皮肤缺损患者。术中按照标记线切除肿物后,在肿物一侧或两侧标记松弛的上睑或下睑皮肤量,按照重睑或眼袋延长线切开皮肤,在靠近皮肤缺损区的上方或下方留5 mm左右宽的蒂,分离皮瓣,并带有少量的眼轮匝肌,然后将皮瓣旋转180°,修剪皮瓣后间断缝合,再连续缝合供皮区皮肤切口。术后加压包扎48 h。对术后外观和皮瓣的存活情况进行连续性观察。结果　所有180°旋转皮瓣均在眼睑缺损区良好存活,不需要打包加压,而且皮瓣收缩量低,术后手术瘢痕相对隐蔽。2眼皮瓣在术后早期出现皮瓣尖端发黑;多数皮瓣蒂部早期存在轻度猫耳现象,术后3个月猫耳逐渐平复,除1眼术后6个月因上睑皮肤松弛和猫耳现象而行上睑成形术外,其余患者均无需二次手术。结论　180°旋转皮瓣手术操作相对简单,可避免发生眼睑外翻、变形等并发症,是眼睑前层缺损修复的备选方法。     

改良额肌瓣悬吊术治疗先天性上睑下垂

目的提高儿童中重度先天性上睑下垂的治疗效果。方法对42例（53眼）中重度先天性上睑下垂的儿童施行改良额肌瓣悬吊术：沿重睑线切开皮肤,剪除部分眼轮匝肌,显露睑板,分别作额肌与皮下、额肌与骨膜间的分离,于眉下提起并横形切断额肌,于其内侧向上切开肌瓣达眉上1-1.5cm,外侧向上剪开0.5cm,形成不等边的额肌瓣,三针褥式缝线固定于睑板上缘。结果42例53眼,切口均一期愈合,随访6月～5年,上睑下垂矫正满意,睑缘外形匀称,上睑闭合良好,无复发和并发症。结论改良式额肌瓣悬吊术治疗儿童先天性中重度上睑下垂疗效确切,远期效果较好。     

Total lower lid reconstruction:clinical outcomes of utilizing three-layer flap and graft in one session

METHODS: Seventeen patients with total or near total lower eyelid defect were included. The defects were reconstructed in three layers. Posterior lamella was reconstructed by using tarsoconjunctival free graft from the ipsilateral upper lid and periosteal flap from lateral orbital rim. Mobilization of residual orbicularis muscle provided a rich blood supply; and the anterior lamella was reconstructed by skin flap prepared from upper lid blepharoplasty as a one-pedicular or bipedicular bucket handle flap.RESULTS: The cause of lower eyelid defect was basal cell carcinoma in 15 patients and trauma in two of them. No intraoperative and postoperative complication occurred. Patients were followed from 10 to 15mo postoperatively. Cosmetic results were favorable in all patients and we had acceptable functional results. Thickness of the reconstructed tissue was a concern in early postoperative period.CONCLUSION:Three-layer lower lid reconstruction in one session is an effective technique for total lower lid reconstruction with minimal complications and acceptable functional and aesthetic outcomes and can be considered as a safe alternative for the preexisting techniques.     

Extensive full-thickness eyelid reconstruction with rotation flaps through “subcutaneous tunnel” and palatal mucosal grafts

AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions. This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a “subcutaneous tunnel” in conjunction with a palatal mucosal graft employed for lining.METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between 2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized, leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a “subcutaneous tunnel” to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.RESULTS:All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible. The defects were repaired completely, and the evaluations showed satisfactory function and appearance.CONCLUSION: This technique is an improved single-stage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.