儿童下睑赘皮性倒睫的手术矫正

目的介绍一种简单有效治疗儿童下睑赘皮性倒睫的手术方法。方法应用皮肤轮匝肌切除联合睫毛外翻缝线术治疗儿童下睑赘皮性倒睫46例92只眼,年龄3~12岁,平均5.4岁。术后随访观察6~24个月。结果治愈82只眼,治愈率89.1%;好转10只眼,好转率10.9%。随访期间无加重。5只眼复发,再次手术后均治愈。总有效率100%。结论皮肤轮匝肌切除联合睫毛外翻缝线术治疗儿童下睑赘皮性倒睫疗效确切,复发率低,无严重并发症。     

三角形皮肤切除矫正内眦赘皮联合重睑成形术

近年来我们在重睑成形术中同时矫正内眦赘皮，缩短了手术周期，术后内眦部瘢痕不明显，取得满意效果。     

下睑赘皮性倒睫汉族儿童睑板宽度测量及睑板发育特征分析

目的 测量汉族下睑赘皮性倒睫儿童上、下睑板的宽度,并分析其睑板发育特征。设计前瞻性病例系列。研究对象2018-2022年北京同仁医院眼科下睑赘皮性倒睫2～13岁儿童258例(516眼)。方法全麻手术开始前使用精确度为0.5 mm的钢尺手术显微镜下测量上、下睑板宽度,包括上睑内侧、上睑中央、上睑瞳孔颞侧缘及上睑外侧睑板宽度,下睑内侧、下睑中央、下睑外侧睑板宽度。主要指标睑板宽度。结果258例儿童的上睑内侧、上睑中央、上睑瞳孔颞侧缘、上睑外侧的睑板宽度分别为(4.76±0.74)mm、(8.05±0.70)mm、(8.47±0.74)mm、(7.07±0.78)mm。下睑内侧、下睑中央、下睑外侧的睑板宽度分别为(3.18±0.49)mm、(3.87±0.51)mm、(3.84±0.54)mm。上、下眼睑的睑板宽度在性别上无明显差异。上睑中央处睑板宽度0～3岁组(21例)、4～6岁组(147例)、7～9岁组(72例)、10～13岁组(17例)分别为(7.71±0.46)mm、(7.95±0.65)mm、(8.25±0.70)mm、(8.59±0.94)mm;下睑中央处睑板宽度0～3岁组、4～...     

先天性下睑赘皮伴下睑内翻的分型治疗及效果

目的 尝试对先天性下睑赘皮伴下睑内翻进行分型，并观察根据分型设计手术方式的手术疗效。 设计 前瞻性病例系列。研究对象 2017年1月至2018年12月在北京同仁医院手术治疗的先天性下睑赘皮伴下睑内翻患者122例（232眼）。 方法 下睑赘皮伴下睑内翻分为三型：内侧型、中央型和全眼睑型。内侧型行小切口下睑赘皮伴下睑内翻矫正术，中央型行新月形切口下睑赘皮伴下睑内翻矫正术，全眼睑型行眼睑全长切口下睑赘皮伴下睑内翻矫正术。“有效”定义为术后1个月眼睑位置形态正常，下睑睫毛背离眼球表面、不触及角膜，畏光、流泪、眼刺痛等角膜刺激症状消失，角膜染色阴性。“复发”定义为术后1个月后重新出现睫毛倒向眼球，并出现角膜刺激症状。随访时间为24个月。主要指标 有效率及复发率。结果122例（232眼）患者中，下睑赘皮伴下睑内翻内侧型98眼（42.24%），中央型20眼（8.62%），全眼睑型114眼（49.14%），均顺利完成手术，术后随访24个月，有效率各型均为100%。内侧型2眼（2.04%）复发，中央型无复发，全眼睑型2眼（1.75%）复发。结论 不同分型的先天性下睑赘皮伴下睑内翻，选择对应的手术设计方案，可获得良好的手术效果。     

中国汉族下睑赘皮性倒睫儿童睑缘宽度的人体学测量

目的 使用眼科规尺测量中国汉族下睑赘皮性倒睫儿童的睑缘宽度。方法 前瞻性单中心观察性研究。使用眼科规尺通过手术显微镜,在全麻状态下对194例下睑赘皮性倒睫儿童进行睑缘宽度的测量。结果194例下睑赘皮性倒睫儿童中男性97例,女性97例,平均年龄6.30±2.94岁(2～14岁),均为汉族。下睑赘皮性倒睫儿童的睑缘宽度:上眼睑内侧、中央、外侧的睑缘宽度分别为1.35±0.29mm,1.61±0.29mm,1.71±0.26mm,上睑睑缘平均宽度为1.56±0.32mm。下眼睑内侧、中央、外侧的睑缘宽度分别为0.94±0.22mm,0.97±0.20mm,1.18±0.25mm,下睑睑缘平均宽度为1.03±0.25mm。不同性别比较,睑缘宽度无显著性差异;不同年龄分组比较,≥8岁儿童的上睑缘宽度明显大于8岁以下的儿童,而下睑无显著性差异。结论 下睑赘皮性倒睫儿童的上睑睑缘宽度明显大于下睑睑缘宽度,上睑外侧睑缘最宽,下睑内侧睑缘最窄。睑缘宽度与性别无关,与年龄有关。本研究为儿童人体学测量提供数据。     

L型皮肤切除矫正下睑赘皮及下睑内翻倒睫疗效观察

有下睑赘皮时,可以因下睑皮肤皱褶压迫睫毛使其倒向后方而磨擦角膜。单纯用缝线法做内翻倒睫矫正,因下睑皮肤皱褶不切除,成功率低。2004年4月至2007年3月,我们对13例患儿进行下睑L型皮肤切除术,既矫正了轻度的下睑内眦赘皮,又矫正了下睑内翻倒睫。经随访6个月-3年以上,疗效确切,现报告如下。     

横形切口内眦赘皮与重睑联合手术的临床效果

目的 在矫正内眦赘皮的同时,完成重睑成形术,获得较理想的重睑和内眦形态.方法 自2008年5月至2011年5月对58例患者采用内眦横切口、形成内眦角切开法重睑成形联合手术.结果 术后随访6个月,内眦赘皮矫正明显,重睑美观自然,内眦瘢痕不明显.结论 横形切口内眦赘皮矫正与重睑联合手术是一种有效、简单的矫正内眦赘皮获得良好重睑形态的方法.     

合并内眦赘皮的重睑术

目的：寻求一种简单有效的内眦赘皮手术治疗方法。方法：通过观察内眦部解剖的特点了解内眦赘皮的形成原因，设计出将内眦部眼轮匝肌和内眦韧带的修复固定，同时一次完成内此成形及重险术。结果：72例不同类型的内眦赘皮，Ⅱ级和Ⅲ级23例，术后经过3－12月随访手术切口产痕3月后逐步软化，有2例肤色较深的患者内眦部切口瘢痕到6月后才不大明显，余效果满意。结论：该方法操作容易，术后外形满意，内眦形态好，瘢痕不明显，患者易于接受。     

先天性下睑内翻并内眦赘皮的手术治疗

目的:探索一种简便而有效的矫治先天性下睑内翻并内眦赘皮的手术方法.方法:患者15例29眼,采用内眦重建联合皮肤轮匝肌切除术:伴倒向型内眦赘皮者行L型皮肤轮匝肌切除术;伴其它类型内眦赘皮者行y-v成形术联合皮肤轮匝肌切除术.结果:术后随访6~12mo,所有患者下睑内翻及内眦赘皮均矫正满意,睑裂横径延长,内眦角自然,取得较好的美容效果,家长及患者满意.结论:联合手术的方法简便有效,利于下睑生理功能恢复,术后瘢痕不明显,提高了先天性下睑内翻的矫治疗效,患者术后不易复发,可作为先天性睑内翻常规手术方法.     

Surgical correction of recurrent epiblepharon in Chinese children using modified skin re-draping epicanthoplasty

AIM:To evaluate the clinical efficacy of the modified skin re-draping epicanthoplasty procedure for correction of recurrent lower lid epiblepharon in Chinese children.METHODS:From 2016 to 2018,18 children(10 males and 8 females,average age 6.2±1.7 y;30 eyes)with recurrent epiblepharon who attended Beijing Children’s Hospital were included in the study.All the children had undergone lower eyelid surgery for epiblepharon.Surgical design included using an additional incision along the upper palpebral margin,to avoid vertical scarring on the upper lid.The re-draping method was used to correct recurrent epiblepharon.Follow-up ranged from 3 to 24 mo.Postoperative surgical outcomes,complications,and subjective satisfaction were evaluated.RESULTS:Complete correction of cilia touching the cornea was observed in all patients during an average follow-up of 7.1 mo.Nodog earsor obvious scars were formed after surgery.All parents were satisfied with the cosmetic results and none complained.Mean astigmatism decreased from 2.39±0.79 diopter(D)preoperatively to 2.19±0.79 D at 6 mo after surgery;however,the difference was not significant.Best-corrected visual acuity improved,although the change in mean visual acuity was not significant.No recurrence occurred during the follow-up period.CONCLUSION:This surgical modified skin re-draping technique is effective and highly satisfactory for correction of recurrent epiblepharon.The approach is characterized by a simple design,a straightforward procedure,inconspicuous scarring,and good postoperative appearance.     

Surgical correction for lower lid epiblepharon in Asians

BACKGROUND/AIMS: Epiblepharon is a congenital lid anomaly in which a fold of skin and underlying orbicularis muscle push the lashes against the eyeball. It is important to get a good lash eversion effect without forming a prominent lid crease in Asian patients. The surgical effect of this rotating suture technique was evaluated. METHODS: Surgical correction for epiblepharon was performed on 197 patients and the results analysed in 169 patients who had been followed for 1 month or more. After subciliary incision, several buried 8-0 nylon sutures were placed to allow adhesion between the tarsal plate and the subcutaneous tissue of the upper skin flap with minimal resection of pretarsal orbicularis and redundant skin. RESULTS: 156 patients (92.3%) showed satisfactory results during 7.1 months of average follow up. Reoperation was performed only on two patients out of 13 because of mildness of symptoms and signs. Complications were minimal including suture abscesses in four patients and wound dehiscence in one. CONCLUSION: The rotating suture technique was very effective in repairing epiblepharon without forming a prominent lower eyelid crease.     

The effect of epiblepharon surgery on visual acuity and with-the-rule astigmatism in children

Purpose

To evaluate the effect of epiblepharon surgery on visual acuity and with-the-rule astigmatism in children compared to patients without surgical treatment.

Methods

We undertook a retrospective case control study and reviewed the charts of 202 eyes treated with epiblepharon surgery and of 142 eyes without surgery. The surgical procedure for epiblepharon correction used rotating suture techniques. Data regarding age, best corrected visual acuity, and degree of astigmatism were recorded. Baseline and 1-, 3-, 6-, and 12-month postoperative data were collected. The chi-square test, Student''s t-test and general linear model analysis for repeated measures were applied.

Results

The mean astigmatism in the surgical group decreased from 1.10 ± 1.02 diopter (D) preoperatively to 0.84 ± 1.05 D at 3 months after surgery (p < 0.05). However, there was no statistically significant difference compared to the non-surgical group during the first year. The general linear model analysis comparing the mean astigmatism between the two groups over time showed a significant group-time interaction (p < 0.05). Within the surgical group, the higher baseline astigmatic subgroup and the 5- to 8-year-old group demonstrated greater cylinder reduction over time. The change in mean visual acuity was not significant in either group.

Conclusions

Significant astigmatic reduction was found after surgical correction in epiblepharon patients. Patients with higher baseline astigmatism exhibited greater astigmatic reduction after epiblepharon surgery. These results suggest that, in order to reduce astigmatism, an epiblepharon operation should be considered in patients with a high level of astigmatism.     

过睑板下缘连续缝合内固定联合眶隔整复治疗下睑赘皮

目的 评价应用皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术,或联合眶隔整复术治疗下睑赘皮的疗效,并分析相关的解剖结构特点.方法 回顾性病例系列研究.回顾分析2006年4月至2010年4月于我院诊断为下睑赘皮并行皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术,或联合眶隔整复术的14例患者的临床资料,患者年龄为13～30岁,均为双眼发病.所有患者均采用这种改良术式,其中8例还同时行眶隔整复术.术后随访4个月～4年,平均随访13个月.观察手术疗效：下睑赘皮及倒睫是否完全矫正,症状是否缓解,有无并发症出现及是否复发等.结果 所有患者均行皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术,其中8例（57%）术中发现眶隔附着点较高,同时行眶隔整复术.术中发现解剖特点为：所有患者均有下睑皮肤、皮下组织、眼轮匝肌向睑缘部堆积,10例睑缘部眼轮匝肌肥厚,8例眶隔附着点较高.术后27眼（96%）完全矫正,1眼（4%）残留轻度下睑赘皮.所有患者术后均无复发及并发症.结论 皮肤、眼轮匝肌部分切除＋过睑板下缘连续缝合内固定术是治疗下睑赘皮的有效方法,对于眶隔附着点较高者,需同时行眶隔整复术.     

晶状体手术矫正老视的治疗进展

老视是与眼睛调节能力下降密切相关的生理现象。不论年轻时屈光状态如何,老视都是人一生中必须经历的阶段。随着老龄化人口数量的增多,老视问题得到越来越多眼科工作者的关注,各种治疗老视的方法与技术也应运而生。现就晶状体手术用于矫正老视进行综述。     

Surgical correction of Hallermann-Streiff syndrome: a case report of esotropia, entropion, and blepharoptosis

We report a case of surgical treatment for Hallermann-Streiff syndrome in a patient with ocular manifestations of esotropia, entropion, and blepharoptosis. A 54-year-old man visited Yeouido St. Mary's Hospital complaining of ocular discomfort due to cilia touching the corneas of both eyes for several years. He had a bird-like face, pinched nose, hypotrichosis of the scalp, mandibular hypoplasia with forward displacement of the temporomandibular joints, a small mouth, and proportional short stature. His ophthalmic features included sparse eyelashes and eyebrows, microphthalmia, nystagmus, lower lid entropion in the right eye, and upper lid entropion with blepharoptosis in both eyes. There was esodeviation of the eyeball of more than 100 prism diopters at near and distance, and there were limitations in ocular movement on lateral gaze. The capsulopalpebral fascia was repaired to treat the right lower lid entropion, but an additional Quickert suture was required to prevent recurrence. Blepharoplasty and levator palpebrae repair were performed for blepharoptosis and dermatochalasis. Three months after lid surgery, the right medial rectus muscle was recessed 7.5 mm, the left medial rectus was recessed 7.25 mm, and the left lateral rectus muscle was resected 8.0 mm.     

Lid margin split in the surgical correction of epiblepharon

Purpose: To describe the technique of splitting the lid margin combined with the excision of redundant skin and muscle during the surgical correction of epiblepharon and to report its clinical outcome. Methods: A combined procedure that included splitting the lid margin to repair lower eyelid epiblepharon was performed on 31 eyes of 19 consecutive patients. Lid margin splitting was performed along the grey line on the medial third or half of the lower eyelid by making a 1 mm‐deep incision. Having made a transverse subciliary skin incision and a dissection between the tarsus and the orbicularis oculi muscle, the subcutaneous tissue of the superior edge of the incision was secured to the tarsus with interrupted sutures to evert the cilia. An excision of the redundant skin and orbicularis tissue was made and the skin was closed. The patients were followed for direct inspection of the wound, the split lid margin, the direction of the lashes and the status of the cornea. Results: The mean postoperative follow‐up period was 29.4 weeks. Symptoms disappeared in all patients. In 30 eyelids of 19 patients the cilia did not touch the cornea, even in the down‐gaze. In one eyelid the cilium touched the medial conjunctiva, but not the cornea. The cosmetic outcome of the lower lid was satisfactory in all cases and the wounds of the split lid margin healed without scarring. To date, there have been no complications such as wound dehiscence, ectropion or eyelid retraction. Conclusions: The lamellar splitting of the lid margin is a beneficial addition to the repair of prominent lower lid epiblepharon, especially on the medial aspect of the eyelid. This simple technique ensures easier eversion of the cilia in epiblepharon repair, without disturbing the posterior lamella or causing unfavourable results.