改良外眦韧带缩短联合眼轮匝肌缩短术治疗退行性下睑内翻的效果

目的 探讨改良外眦韧带缩短联合眼轮匝肌缩短术治疗退行性下睑内翻的效果。设计 回顾性病例系列。研究对象 北京同仁医院79例（118眼）退行性下睑内翻患者。方法 对所有患者行改良外眦韧带缩短联合眼轮匝肌缩短术,术后随访12个月,对手术效果（眼睑位置、形态、有无溢泪）及复发率进行评估。主要指标 手术效果和复发率。结果 末次随访时,117眼治愈,其中3眼术后早期出现轻度过矫,3眼中2眼眼睑位置形态于术后3个月恢复正常,另1眼于术后6个月恢复正常。1眼复发。结论 随访1年的结果显示,改良外眦韧带缩短联合眼轮匝肌缩短术治疗退行性下睑内翻效果确切,治愈率高,复发率低。     

改良Wies法治疗退行性下睑内翻的一年疗效

目的 探讨改良Wies法治疗退行性下睑内翻的疗效。设计 回顾性病例系列。研究对象 北京同仁医院眼科中心27例（31眼）退行性下睑内翻患者。方法 27例（31眼）均采用改良Wies法（横行切透下睑,将下睑缩肌前徙固定于皮肤及睑板）。观察术前术后患者眼睑形态、睑缘位置等,随访（14.6±3.5）个月（12~17个月）。主要指标 眼睑形态、睑缘位置、有无溢泪。结果 术前1例复发患者,在术后14个月,双眼再次内翻复发。其余26例患者,在随访期间均未见过矫或复发,睑缘位置形态好,无不适主诉。结论 改良Wies法简单快速易重复效果好,对于治疗退行性下睑内翻建议优先考虑。     

下睑缩肌移位联合外眦韧带缩短术矫正退行性下睑内翻

目的：观察和对比下睑缩肌移位联合外眦韧带缩短术及单纯眼轮匝肌切除术治疗老年退行性睑内翻的方法及疗效。
　　方法：收集我院因退行性睑内翻住院的患者,观察组共40例70眼,双眼发病30例,采用下睑缩肌移位联合外眦韧带缩短术治疗退行性下睑内翻;对照组共20例26眼,其中双眼发病6例,采用眼轮匝肌切除术治疗退行性下睑内翻,观察两组患者术后1 wk的矫正率、双眼睑对称性、过矫率;并随访6mo,观察远期复发率、双眼睑对称性、过矫率。
　　结果：术后1 wk拆线时观察,观察组矫正率98.6%,欠矫率1.4%,眼睑对称性100%,仅有1眼轻度过矫;对照组矫正率92.3%;眼睑对称性100%,欠矫率7.7%。术后6mo观察组矫正率95.2%;欠矫率3.2%,过矫率1.6%。对照组矫正率87%,2眼复发,1眼欠佳。双眼睑对称性、过矫率方面差异无明显统计学意义(P>0.05),在矫正率方面两者有明显差异(P<0.05)。
　　结论：下睑缩肌移位联合外眦韧带缩短术与眼轮匝肌切除术治疗退行性下睑内翻相比,下睑缩肌移位联合外眦韧带缩短术长期疗效术后复发率明显降低。     

改良皮肤及眼轮匝肌切除术治疗先天性下睑内翻

目的 探讨改良下睑皮肤及眼轮匝肌切除术治疗先天性下睑内翻的效果.方法 对27例(46眼)先天性下睑内翻行改良下睑皮肤及眼轮匝肌切除术,根据睑内翻程度决定切除量,皮肤及眼轮匝肌的最大切除量在内眦部.术中切除的眼轮匝肌包括睑板前及部分眶隔前轮匝肌,16眼复发性下睑内翻加局部灰线切开.所有患眼均采用7-0美容线内翻处皮肤潜行挂睑板约1.5mm间断缝合,外侧皮肤间断缝合.结果 随访6个月～2年.44眼治愈,2眼好转.所有患者术后1周肿胀消退,下睑皮肤切口处平整.结论 改良皮肤眼轮匝肌切除术治疗先天性下睑内翻,疗效较好.     

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.     

老年性下睑内翻手术的改良--睑轮匝肌下移法

目的尝试对老年性下睑内翻的手术方法进行改良,力求简单易学,对患者损伤小。方法利用卧位下自然注视眼位判断切除松弛的下睑的皮肤量。不破坏肌鞘膜,将睑板前轮匝肌束下移固定缝合在下睑眶隔膜上。强调皮肤切口外眦缝合挂外眦韧带。结果临床用22例26只眼,追踪观察6年,效果全部满意,无一例复发。结论睑轮匝肌下移法手术设计符合生理功能,简单易学,对患者损伤小,在社会老龄化的今天有实际临床应用价值。     

改良式下睑内翻矫正术的临床疗效观察

目的 探讨下睑内翻倒睫,切除下睑皮肤、轮匝肌,皮内带睑板缝合矫正内翻倒睫,同时可以美容的手术方法及疗效.方法 对47例(75眼)下睑内翻倒睫的病例采用皮肤、部分轮匝肌切除,皮内带睑板缝合法矫正.结果 对47例(75眼)下睑内翻倒睫的病例采用皮肤、部分轮匝肌切除,皮内带睑板缝合法,倒睫全部矫正无双重睑出现.结论 对下睑内翻倒睫的患者行皮肤、部分轮匝肌切除,皮内带睑板缝合法下睑内翻倒睫可得到良好矫正,方法简单、可靠且同时起到良好的美容效果.     

睑板切开缝线联合眼轮匝肌及皮肤切除治疗下睑内翻

老年性睑内翻多发生在下睑 ,是由眼睑组织老年性退行性变化引起 ,是常见的外眼病。 1995年至今我们采用睑板切开缝线联合睑缘轮匝肌及皮肤切除治疗复发性、严重下睑内翻患者 35例 (5 0只眼 ) ,随访观察 2 8例 (4 0只眼 ) 6个月～ 3年 ,疗效满意。一、资料和方法住院病人 3例 (5只眼 ) ,门诊病人 32例 (4 5只眼 ) ,年龄最大 76岁 ,最小 5 5岁 ,平均年龄 6 5 .5岁 ,双眼 2 6例 ,单眼 9例 ,共 35例 (5 0只眼 )。常规消毒铺无菌巾 ,2 %利多卡因加少许肾上腺素 ,做眼睑及穹窿部浸润麻醉 ,4号丝线穿 4根三角 12 7× 17号皮针 ,分别从穹窿部进针。…     

治疗退行性睑内翻的一种简单术式

手术是治疗睑内翻的主要方法。眼轮匝肌内注射肉毒素的方法只能暂时缓解症状,而单纯采用眼睑粘贴又常引起皮肤炎症,有损美观。外侧睑板剥离和下睑缩肌复位一类的手术需要谙熟下睑解剖尤其是下睑缩肌的位置和功能,难以掌握。作者采用外侧睑板剥离结合翻转缝线的方法治疗退行性睑     

下直肌鞘纤维离断术矫治先天性下睑内翻

目的从眼外肌解剖及眼球运动的特点阐述先天性下睑内翻的发病机制,探索下直肌鞘纤维分离用于矫治先天性下睑内翻的效果。方法对31例61眼先天性下睑内翻倒睫从下穹窿部行下直肌鞘纤维离断或联合穹窿眼睑皮肤缝线术及术后下睑缝线牵引。术后随访3～36个月。平均随访18.64个月。结果29例57眼一次手术完全矫正,占93.55%,2例4眼复发,占6.45%。结论先天性下睑内翻的发病机制不同于传统概念原因。运用下直肌鞘纤维离断符合生理解剖关系或联合穹窿眼睑皮肤缝线术治疗先天性下睑内翻临床疗效确切。     

Orbicularis oculi muscle extirpation in a combined procedure for involutional entropion

Many factors are important in the pathophysiology of involutional entropion, including defects of the lower eyelid retractors, canthal tendon laxity, and acquired enophthalmos. The role of the overriding preseptal orbicularis oculi muscle is often ignored in modern techniques of entropion repair. The author describes a technique of extirpation of the preseptal orbicularis oculi muscle combined with repair of the lower eyelid retractors and a lateral tarsal strip procedure for the repair of primary and recurrent involutional entropion. Lateral canthal tendon laxity is recognized in most patients in this age group and must be corrected to avoid postoperative overcorrection and ectropion. Removal of the preseptal muscle had no clinical effect on the lacrimal pump and did not cause any significant cicatricial eyelid abnormalities. This combined procedure has been used in 50 eyelids of 40 patients with excellent functional and cosmetic results. Orbicularis extirpation is not advocated in combination with a marginal rotation 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。     

Role of reinsertion of the lower eyelid retractor on involutional entropion

AIMS: To verify and evaluate the effect of reinsertion of the lower eyelid retractor aponeurosis to correct involutional entropion. METHODS: The involutional entropion is one affection that occurs mainly in the lower eyelid of patients over 60 years old. The surgical techniques proposed to correct this condition are based on correction of horizontal laxity-the preseptal orbicularis muscle overrides the pretarsal muscle, and the reinsertion of the lower eyelid retractor aponeurosis. 30 patients clinically diagnosed with involutional entropion and randomly selected underwent reinsertion of the lower eyelid retractor aponeurosis to the tarsal plate, without horizontal shortening or resection of the skin or orbicularis muscle. RESULTS: Good anatomical and functional correction was achieved in 96.6% of the patients and no recurrence was observed on 29 month follow up examination. The surgical result was very satisfactory. CONCLUSIONS: It was concluded that this procedure is effective and has low recurrence rate, showing the important role of the reinsertion of the lower eyelid retractor aponeurosis in this surgical correction.     

Involutional entropion surgery: a modified technique

PURPOSE: A study to evaluate the effectiveness of a modified procedure to correct involutional entropion. METHODS: Seventeen cases of involutional entropion underwent surgery and had a postoperative follow-up of 18 months. The authors describe a technique of vertically shortening the anterior lamella (skin and orbicularis muscle), using a blepharoplasty incision and reflection of a skin muscle flap. RESULTS: In 16 of 17 eyelids affected by involutional entropion, this operative procedure showed good functional outcome (good correction of the relation between lower eyelid edge and eyeball) and aesthetic outcome (no hypertrophic scar, dyschromia or unnatural folding of the skin). CONCLUSIONS: A correct approach to entropion surgery needs an accurate preoperative evaluation of the individual physiopathogenic factors. This procedure gives lasting functional and pleasing cosmetic results when preseptal orbicularis muscle override has been identified as the cause of senile entropion.     

Orbicularis oculi muscle transposition for repairing involutional lower eyelid entropion

Purpose

To describe a simple technique for involutional entropion correction and to present the findings of a retrospective interventional case series study.

Methods

We studied a consecutive series of 414 patients (609 eyelids). Patients presenting with involutional entropion in the absence of lateral canthal tendon laxity underwent orbicularis oculi muscle (OOM) transposition from pretarsal position to corresponding preseptum without horizontal shortening or resection of the orbicularis muscle.

Results

Immediate resolution of entropion and associated ocular symptoms was achieved in 607 eyelids (99.67 %). An early postoperative complication was localized lid swelling that gradually subsided within one week. Over-correction occurred in six cases and resolved with pressure dressing, mostly one or two days post-operation. At final follow-up, a significant improvement in eyelid position was achieved in 579 eyelids (95.07 % ). There was mild recurrence of entropion in 30 eyelids (4.93 %). The mean follow-up was 6.84 months (range, 6–12 months).

Conclusions

Orbicularis oculi muscle transposition is a reasonably successful procedure with a high success rate, and is particularly suitable for patients for whom there exits overriding of the preseptal OOM over the pretarsal OOM.     

Involutional entropion repair with fornix sutures and lateral tarsal strip procedure

PURPOSE: To evaluate the long-terrm effectiveness of fornix suture placement combined with a lateral tarsal strip procedure in correcting involutional entropion. Published reports regarding various surgical techniques and results are reviewed. METHODS: This retrospective study reviewed 119 patients with involutional lower eyelid entropion who underwent surgical repair between January 1987 and May 1999 at the Bascom Palmer Eye Institute. Exclusion criteria included follow-up duration of less than 6 months, previous lower eyelid blepharoplasty, previous conjunctival surgery other than chalazion removal, or cicatricial entropion. The three surgical subsets were (1) combined lateral tarsal strip and fornix sutures: (2) fornix sutures alone; and (3) lateral tarsal strip procedure alone. The chart review was complemented by a telephone questionnaire to assess the long-term clinical outcome, complications, and patient satisfaction. RESULTS: One hundred fifty-two eyelids in 119 patients were included. One hundred twenty-five eyelids had combined surgery (lateral tarsal strip with fornix sutures), 9 eyelids had only fornix suture repair, and 18 eyelids had repair with only the lateral tarsal strip procedure. The recurrence rate in these three surgical subsets was 1.6%, 33%, and 22%, respectively, with average follow-up of 36 months. One case of incisional cellulitis was encountered. Postoperative ectropion was not seen in the group having the combined lateral tarsal strip and fornix suture procedure. CONCLUSIONS: Suture advancement of the lower eyelid retractors in conjunction with a lateral tarsal strip procedure is a simple, quick, physiologic, and effective approach in achieving long-lasting correction for involutional entropion.     

Lateral tarsal strip and quickert sutures for lower eyelid entropion

PURPOSE: To evaluate the long-term outcome of involutional entropion repair by means of a combined procedure of lateral tarsal strip and Quickert everting sutures. METHODS: Noncomparative interventional case series of patients who underwent a combined procedure of lateral tarsal strip and Quickert sutures for treatment of involutional entropion between September 1999 and September 2002. Of 75 patients who underwent surgery, 36 were followed for at least 2 years. At the 2-year clinical examination, patient comfort, complications, recurrence rates, overcorrection, and cosmetic appearance were assessed. RESULTS: The average age of the 36 patients was 76.67 years. There were 5 bilateral cases, for a total of 41 eyelids. Nine eyelids underwent the procedure to correct recurrent entropion. The recurrence rate was 0% at 1 month after surgery, 2 of 41(4.9%) at 6 months, and 5 of 41 (12.2%) at 2 years. The recurrence rate after a primary procedure was 3 of 32 (9.4%), and, after a failed previous procedure, 2 of 9 (22.2%). There were no cases of secondary ectropion, and all patients were happy with their cosmetic appearance. CONCLUSIONS: A combined lateral tarsal strip and Quickert sutures procedure is effective, simple, and addresses all of the factors that contribute to involutional entropion formation, with a good long-term success rate and cosmetic outcome.     

Four-snip procedure for involutional lower lid entropion: modification of Quickert and Jones procedures

Involutional lower lid entropion results from a faulty lower lid retractor complex, lid laxity and overriding of preseptal orbicularis fibres on the tarsal and pretarsal fibres. The author describes the anatomy of the lower lid and presents a four-snip procedure for correcting this condition in which the Quickert and Jones techniques are combined.     

Primary and secondary transconjunctival involutional entropion repair

PURPOSE: Lower eyelid involutional entropion is a significant disorder of the aging population resulting from horizontal eyelid laxity, overriding orbicularis oculi muscle, and attenuation of the lower eyelid retractors. The purpose of this study is to describe the long-term results of transconjunctival entropion repair. DESIGN: Interventional noncomparative case series. PARTICIPANTS: Thirty-six eyelids in 31 patients. METHODS: Charts were reviewed of all transconjunctival entropion repairs, which included myectomy, retractor fixation, and horizontal shortening performed by three oculoplastic surgeons between January 1993 and January 1999. Cases with less than 12 months follow-up were excluded. MAIN OUTCOME MEASURES: Entropion recurrence. RESULTS: Thirty-six lids in 31 patients were followed for mean of 31.5 months (12.5-79). Six of 36 lids (16.7%) had postoperative complications. Recurrent entropion occurred in 3 of 36 lids (8.3%) an average 16.3 months (7-35) after surgery. An average of 6 trichiasis lashes (1-10) occurred in 4 of 36 lids (11.1%) at a mean of 2.25 months (1-4) after surgery. There were no overcorrections. Three of 36 lids (8.3%) required additional surgery. CONCLUSIONS: Entropion recurrence after three-step transconjunctival repair is within the 0% to 30% reported recurrence for other repair techniques but more frequent than reported for a similar transcutaneous procedure. The 8.3% recurrence rate might have resulted from inadequate myectomy, inadequate retractor fixation, cicatricial changes directly related to the transconjunctival incision, or progressive involutional changes. Trichiasis was the most frequent complication. Transconjunctival entropion repair may be slightly less effective than transcutaneous repair.