经典提上睑肌缩短术治疗重度先天性上睑下垂

目的评估经典提上睑肌缩短术治疗重度先天性上睑下垂及手术治疗效果。方法重度先天性上睑下垂20眼行经典提上睑肌缩短术结果本文16例20眼,平均随访6个月。术后睑裂高度7～9mm者18眼,6mm者2眼,双眼睑裂对称,重睑弧度自然,部分病例有轻度睑裂闭合不全,4眼一过性轻度结膜脱垂。结论该术式矫正重度先天性上睑下垂效果良好。     

异种脱细胞真皮基质联合邻位皮瓣修复眼睑全层缺损的临床观察

目的 观察异种脱细胞真皮基质联合邻位皮瓣Ⅰ期修复眼睑恶性肿瘤切除术后眼睑全层缺损的临床疗效.万法 35例(35眼)眼睑恶性肿瘤患者,其中基底细胞癌21例,睑板腺癌13例,鳞状细胞癌1例;累及上睑者12例,累及下睑者23例.所有患者均行术中冰冻并根据冰冻结果确定切缘,肿物切除后眼睑有不同程度全层缺损.取异种脱细胞真皮基质替代结膜睑板组织,根据皮肤缺损大小做邻近滑行或转位皮瓣修补眼睑缺损.术后观察皮瓣及口腔修复膜愈合情况、有无眼睑闭合不全及睑球粘连.结果 随诊半年,异种脱细胞真皮基质已完全溶解,被爬行结膜上皮覆盖,皮瓣愈合良好、无一例皮瓣坏死.其中28例患者术后恢复良好,无眼睑闭合不全及睑内、外翻.4例患者出现轻度眼睑闭合不全,均无暴露性角膜炎.3例患者出现轻度睑球粘连.结论 异种脱细胞真皮基质可替代睑板结膜组织,联合邻位皮瓣治疗眼睑恶性肿瘤切除术后的眼睑全层缺损有较好的临床疗效,可减少患者因取口唇黏膜或行二次眼睑重建的痛苦.     

改良睑板-Müller肌切除术治疗轻度上睑下垂疗效观察

目的探讨改良睑板-Muller肌切除术治疗轻度上睑下垂的疗效。方法轻度上睑下垂16例(16只眼),行改良睑板Muller肌切除术治疗,术后随访至少3个月。结果 16例中13例完全矫正,3例基本矫正,眼睑外形满意。结论改良睑板-Muller肌切除术操作简便,术后并发症少,矫治轻度上睑下垂疗效可靠。     

自体睑皮瓣悬吊术在治疗上睑下垂中的应用

目的 观察自体睑皮瓣悬吊术在治疗上睑下垂中的应用疗效。方法 选择上睑下垂患者49例（55眼），在全麻或局麻下，将自体眼睑皮肤形成皮瓣作为悬吊材料，联合缝线悬吊法对上睑下垂进行矫正手术。结果 术后次日睁眼时睑缘位置高于瞳孔区，闭眼时睑裂轻度闭合不全。术后随访6—12个月，睁眼时眼睑位置正常或基本正常，闭眼时闭合完全或微小闭合不全。结论 自体睑皮瓣悬吊术治疗上睑下垂是值得推荐的一种手术方式，手术解剖学要求相对低，手术安全性高，悬吊材料具有弹性，不会有排斥反应。     

提上睑肌缩短术在治疗中重度先天性上睑下垂中的应用

目的：观察应用提上睑肌缩短术治疗中重度先天性上睑下垂的效果。方法：对39例(56眼)中重度先天性上睑下垂患采用经皮肤-睑结膜入路提上睑肌缩短术。并对术后效果进行随访观察。结果：本组39例(56眼)随访2～18mo，除2眼矫正不足外，余均获得良好效果。上睑缘弧度及双重睑形成良好，术后仅部分病例早期有轻度睑裂闭合不全，无暴露性角膜炎等并发症发生。结论：提上睑肌缩短术可适用于中重度先天性上睑下垂患，在矫正畸形和改善外观方面均能达到良好的效果。     

对位睑板结膜瓣滑行修复眼睑缺损

目的：评价对位睑板结膜瓣滑行修复眼瞪缺损的效果。方法：对41例眼瞪全层缺损患者,其中上睑10例,下睑31例,切除肿瘤导致缺损者33例。外伤导致缺损者8例,缺损范围在1/3-2/3,年龄24-79岁,采用与缺损眼睑相对应的眼睑睑板结膜瓣滑行至缺损区来修补眼睑缺损。结果：术后随访31例,随访时间3月-5年,除缺损外,1例出现轻度上睑退缩（退缩量为1-2mm),1例出现轻度下睑外翻,余眼睑外形及功能均基本恢复,眼睑活动自如,闭合完全,无严重并发症发生,结论：对位睑板结膜瓣滑行可用于修复眼睑后层缺损,且不受有无睑板替代物的限制。不需另添手术创口,可更好地恢复眼睑的功能及外观。     

改良上睑提肌缩短术治疗单侧先天性上睑下垂

目的评估改良上睑提肌缩短术治疗单侧先天性上睑下垂的手术疗效。方法单侧先天性上睑下垂30例（30眼），术前参考健眼上睑缘位置以确定手术量，术中以可调整褥式缝合行改良上睑提肌缩短术。结果随访6个月，30眼中成功26眼（86．67％），其双眼睑裂对称，重睑弧度自然，部分病例有轻度闭合不全但闭合时不露角膜；有效4眼（13．33％），患眼睑裂高度低于健眼的值小于2mm，术眼无闭合不全或闭合不全不明显，但闭合时不露角膜。结论改良上睑提肌缩短术矫正单侧先天性上睑下垂效果良好。     

老年性上睑下垂手术治疗的临床观察

目的 探讨老年性上睑下垂的临床特征及手术治疗。方法 根据老年性上睑下垂不同程度对23例(32只眼)分别行睑板-结膜-Muller氏肌切除术(Fasanella-Fervat)和提上睑肌缩短术。结果 所有病例随访3个月～2年，除采用睑板-结膜-Muller氏肌切除术的-眼长期异物感，采用提上睑肌缩短术的-眼矫正不足外。其余病例均获得较满意效果。结论 睑板-结膜-Muller氏肌切除术和提上睑肌缩短术是治疗不同程度老年性上睑下垂的有效方法。     

可调式硅胶带额肌悬吊术矫治儿童先天性上睑下垂

目的：探讨治疗儿童先天性上睑下垂的手术方法。方法：将1．0mm宽的硅胶带以“U”字型分别缝合在上睑板中部和额肌腱膜上，依靠硅胶带的弹性作用抬高上睑，硅胶带伸张又不影响眼睑闭合，且术后可拉出眉弓处硅胶带残端进行反复调整。其治疗儿童先天性上睑下垂46例（59只眼），并随访观察6个月－2年，平均1年。结果：51只眼一次手术成功，上睑缘弧度美观自然，双睑裂对称，眼睑开闭功能正常；6只眼术后分别出现过矫或欠矫，2只眼并发睑内翻倒睫，经调整或再次手术后得到满意效果；16只眼遗留轻度眼睑闭合不全，无一例发生暴露性角膜炎等并发症。结论：可调式硅胶带额肌悬吊术是治疗儿童先天性上睑下垂较理想的手术方法之一。手术年龄以3－6岁较适宜。     

用易位睑板结膜瓣修复眼睑缺损

用易位睑板结膜瓣修复眼睑缺损郑州市第二人民医院眼科孙芳利用上睑或下睑缺损区以外残存的睑板睑结膜，设计成易位睑板结膜瓣１期修复全层部分睑缺损１０例１２只眼，取得了满意的效果。重建了眼睑功能。达到术后外形的美观。材料及方法一般材料１０例１２只眼，男８例，...     

Immunoglobulin deposition in localized conjunctival amyloidosis

Immunofluorescent studies were performed on tarsus and tarsal conjunctiva from a 30-year-old woman with blepharoptosis secondary to localized nonfamilial amyloidosis. Both kappa and lambda light chains were identified in abundance in the resected tissue. There was no evidence of any systemic disease or of amyloid deposition elsewhere. Six months after the patient underwent surgery, there was no sign of recurrence. The antigenic determinants of the amyloid suggested that the pathogenesis of localized nonfamilial ocular amyloidosis involves the accumulation of proteins similar to immunoglobulin.     

Blepharoptosis repair by fascia lata suspension with direct tarsal and frontalis fixation

Nine patients with blepharoptosis and no levator palpebrae superioris muscle function were treated by fixating irradiated fascia lata to the tarsus and frontalis muscles under direct visualization. No recurrences were noted on follow-up, which ranged from four to 24 months. There were no postoperative infections or granuloma reactions. Cosmetically, the height, contour, and symmetry of the eyelid margin and eyelid crease were predictable and satisfactory. This modified method of frontalis suspension may provide a more predictable and cosmetically pleasing result in the treatment of blepharoptosis when minimal or no levator muscle function is present.     

Modified sutureless sclerotomies in pars plana vitrectomy

PURPOSE: To report late suture migration as a complication of blepharoptosis surgery. METHOD: Case reports. RESULTS: After upper eyelid blepharoptosis repair, two eyes of two patients developed unusual foreign body reactions and ulceration in the conjunctiva caused by migration of nonabsorbable suture from the levator aponeurosis to the upper conjunctival fornix. The foreign body caused eyelid edema, papillary changes in the upper tarsal conjunctiva, recurrent blepharoptosis, and a foreign body sensation that started more than 3 months after the surgery and persisted until the suture was removed. The sutures, hidden in edematous conjunctiva of the superior fornix, eluded detection. CONCLUSIONS: Foreign body reaction secondary to suture migration is an uncommon complication of blepharoptosis repair.     

Effect of Excision of Avascular Bleb and Advancement of Adjacent Conjunctiva for Treatment of Hypotony

Purpose

To evaluate the efficacy of excision of avascular bleb and advancement of adjacent conjunctiva (EBAC) for treatment of hypotony after trabeculectomy with mitomycin C (MMC).

Methods

Fifteen patients (17 eyes) who received EBAC for correction of hypotony between September 1996 and October 2008 were reviewed retrospectively. The main outcomes were intraocular pressure (IOP) and postoperative complications.

Results

Hypotony (IOP <6 mmHg) of eight eyes (47.1%, seven patients) was caused by bleb perforation. Of these, two eyes (two patients) had a history of trauma. Hypotony appeared at 33.9±30.8 months, and EBAC was performed at 48.2±35.3 months after trabeculectomy with MMC. The mean follow-up period was 38.3±29.8 months. The qualified success rate of EBAC was 100% at 51 months after EBAC, and the complete success rate of EBAC was 76.5% at six months and 70.6% at 51 months, as determined by Kaplan-Meier analysis. Post-EBAC complications included blepharoptosis in four eyes (23.5%) and bleb perforation in one (5.9%). The blepharoptosis resolved within one month after EBAC in two patients. However, in the other patients, mild blepharoptosis remained at 17 and 22 months postoperatively.

Conclusions

EBAC was found to be an effective method for treatment of hypotony after trabeculectomy with MMC, and postoperative blepharoptosis was a major complication.     

深低温保存异体睑板睑结膜移植修复眼睑缺损的临床观察

目的 评价深低温保存异体睑板睑结膜移植修复,因眼睑肿物切除造成的眼睑缺损的临床效果.方法 采用深低温保存异体睑板睑结膜移植眼睑再造术修复眼睑缺损21例(21只眼).结果 术后随访3～80月,平均46.9月.本组病例共治愈10只眼,好转11只眼,1例(1只眼)因首次手术时切缘未净再次行扩大切除时未更换移植片导致植片脱落.结论 深低温保存异体睑板睑结膜移植修复眼睑缺损,简便易行,保存方便,术后并发症少,临床效果满意.异体睑板睑结膜是理想的眼睑缺损修复的材料.     

Surgical treatment of postburn cicatricial inversions of the lower eyelids with involvement of the lid edge and conjunctival ectopia

Examinations of 30 patients with postburn cicatricial inversions of the lower lids have revealed involvement of the median half of the tarsus and ciliary edge in approximately 1/5 of them. Conjunctival growth and creeping of the conjunctiva on the edge and outward surface of the eyelid, manifesting as a red spot, are observed at the site of this involvement, where no eyelashes grow. The treatment of 6 patients with such condition has led the authors to a conclusion that ectopic conjunctiva is subject to tangential resection with plasty of the eyelid, its tarsus and ciliary edge, released from the cicatrices, with a single graft of split skin. The technique of surgery is described.     

兔异体睑板睑结膜移植修复眼睑缺损实验研究

目的比较甘油、酒精及深低温3种方法保存兔异体睑板修复眼睑缺损的有效性和术后组织病理学反应及细胞凋亡情况。方法分3组进行甘油、酒精及深低温保存兔异体睑板睑结膜移植修复眼睑缺损各16眼,术后1周、1月及3月分别取材用光镜观察植片的组织病理学改变,并以原位末端标记（TUNEL）技术观察移植后细胞凋亡情况。结果3组术后均有不同程度的炎性反应出现,深低温保存兔异体睑板移植术后临床及组织病理学观察炎性反应轻于甘油及酒精保存材料移植后反应;3组均出现细胞凋亡现象,深低温组移植术后凋亡细胞数量较甘油、酒精组少。结论深低温保存的兔异体睑板移植修复眼睑缺损活性高,简便易行,保存方便,术后并发症少,排斥反应小,是理想的眼睑缺损修复的材料。     

Analysis of treatment results 389 patients with congenital blepharoptosis

PURPOSE: Retrospective analysis of the results in the treatment of congenital blepharoptosis. MATERIAL AND METHODS: We retrospectively reviewed the records of 389 patients with blepharoptosis who underwent surgical treatment in the Hospital of Plastic Surgery in Polanica-Zdrój, from January 1976 to January 2005. The age of patients, degree of malformation and unilateral or bilateral occurrence of ptosis, was analyzed. Moreover, we studied treatment results of patients with blepharoptosis treated in our hospital and patients treated elsewhere, before admission to our hospital. RESULTS: 218 patients from 327 operated in our hospital had levator muscle resections. After 6 months of observation 39 patients were qualified for surgical re-correction. 12 months after surgery 4 patients had recurrence of ptosis. Frontalis suspension technique with using the temporal fascia, was performed in 109 patients. After 6 months observation, 8 patients were qualified for surgical re-correction. CONCLUSIONS: For patients with maintained function of the levator muscle the most effective and physiological procedure, is the muscle shortening. Frontalis suspension technique with use of the temporal fascia should be limited to treat failure cases and patients with poor or absent function of the levator muscle.     

Amniotic membrane transplantation in a case of ligneous conjunctivitis

PURPOSE: To report a case of ligneous conjunctivitis treated with amniotic membrane transplantation. DESIGN: Interventional case report. METHODS: A 44-year-old woman presented with woodlike lesions in the upper and lower tarsal conjunctiva, blepharoptosis, and reduced visual acuity in the left eye. After confirmation of the diagnosis of ligneous conjunctivitis, she underwent amniotic membrane transplantation. RESULTS: At the 2-month, 4-month, and 6-month examinations, the tarsal conjunctiva appeared free from membranes. At 8 months, the patient underwent amniotic membrane transplantation for small recurrences. At the 36-month examination, no membranes were evident, and visual acuity was 20/20. CONCLUSIONS: In this first report of amniotic membrane transplantation in a case of ligneous conjunctivitis, we found that conjunctival reconstruction shows promising results in this difficult-to-manage disease.     

A new algorithm for ptosis repair using conjunctival Müllerectomy with or without tarsectomy

PURPOSE: To determine the predictability of a new algorithm for determining the amount of tissue resection for conjunctival Müllerectomy with or without tarsectomy blepharoptosis repair. METHODS: Consecutive case series of all patients undergoing conjunctival Müllerectomy with or without tarsectomy ptosis repair from October 1999 to September 2001. Each patient underwent excision according to a new algorithm for determining the amount of tissue excision. The amount resected was determined by the following formula: 9 mm of conjunctiva and Müller muscle + x mm of tarsus, where x = distance of undercorrection after phenylephrine testing. RESULTS: Sixty-eight consecutive patients underwent 70 cases of conjunctival Müllerectomy with or without tarsectomy ptosis repair on 117 eyelids, using a new algorithm for tissue excision. Forty-seven cases were bilateral and 23 were unilateral. Postoperative symmetry was found in 58 of 67 patients (87%) after 1 surgery. Patient satisfaction based on symmetry, contour, and height after 1 repair was achieved in 64 of 67 patients. There were no overcorrections. Two patients underwent successful reoperation with a second conjunctival Müllerectomy with or without tarsectomy operation. CONCLUSIONS: This modified algorithm and technique quantifies conjunctival Müllerectomy with or without tarsectomy ptosis surgery and yields predictable results.