The histopathology of involutional ectropion

Twenty eyelid specimens from patients with involutional ectropion, obtained by full-thickness horizontal shortening procedures, were examined histopathologically by light and electron microscopy and compared with six normal eyelids from exenteration specimens. Paralytic, cicatricial, and congenital ectropions were excluded from the study. The main histopathologic features included: (1) collagen degeneration and elastosis of the tarsal plate; (2) increased amounts of adipose tissue in the distal tarsus and capsulopalpebral fascia; (3) subacute inflammation and epidermidalization of the tarsal conjunctiva; (4) focal degeneration, fibrosis and elastosis of pretarsal orbicularis, and occasionally minimal change in the muscle of Riolan; and (5) arteriosclerosis of the marginal artery. The combination of these histopathologic changes characterize and may contribute to the development of ectropion of the eyelid associated with aging.     

退行性下睑内翻的改良矫正术式

目的探讨矫正退行性下睑内翻的改良手术方法。方法对25例（32眼）,退行性（老年性）下睑内翻施行眼轮匝肌缩短、下移固定联合眼睑后层组织的部分切除的手术方式进行治疗。结果退行性下睑内翻32眼均得到良好矫正,术后随访3～6个月未见复发病例。结论本组施行的改良手术方式从多个方面解决了退行性下睑内翻的发病因素,矫正效果良好。     

老年上睑退行性睑内翻手术治疗临床观察

目的 探讨老年上睑皮肤松驰下垂伴外侧退行性睑内翻倒睫用简单、损伤小同时美容的手术治疗方法及疗效,并分析其发病机制。方法 对20例（30眼）老年上睑皮肤松驰并外侧睑内翻倒睫病例采用松驰皮肤切除并重睑缝合法矫正。结果 20例（30眼）经单纯皮肤切除并重睑缝合法倒睫全部矫正,自觉症状消失,睑型自然。结论 对老年人上睑皮肤松驰下垂伴外侧部分睑内翻倒睫的患者行松驰皮肤切除并重睑缝合法可得到良好矫正,且具有美容效果。     

两种手术方式治疗退行性下睑内翻伴眼睑松弛的疗效比较

目的：分析并比较改良式眼轮匝肌缩短术及单纯眼轮匝肌缩短术治疗退行性下睑内翻伴眼睑松弛的临床疗效。

方法：选取2012-01/2014-08我科收治的93例108眼退行性下睑内翻伴眼睑松弛为研究对象,根据手术方式的不同分为观察组(47例52 眼,采用改良式眼轮匝肌缩短术)和对照组(46例56眼,采用单纯眼轮匝肌缩短术)。比较两组患者的短期和长期治疗效果。

结果：观察组与对照组患者在年龄、性别及病程方面比较,差异无统计学意义(P>0.05)。观察组的短期有效率(98%)与对照组(95%)比较,差异无统计学意义(P>0.05); 观察组术后3a的复发率(2%)低于对照组(14%),差异有统计学意义(P=0.033)。

结论：改良眼轮匝肌缩短术治疗退行性下睑内翻伴眼睑松弛较单纯眼轮匝肌缩短术的临床疗效好。     

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。     

Correction of involutional entropion with retractor redirection

The study aims to report the surgical outcome of a retractor redirection procedure for involutional entropion repair for Asians. The study included all cases diagnosed with involutional entropion and significant ocular irritation who presented from 2008 to 2012. Sixty-seven eyelids in 54 patients were included in this study. All cases were operated on by one surgeon and had a minimum of 12-months follow-up. Success was defined as cases showing no recurrence of entropion with forceful eyelid squeezing postoperatively. A retrospective chart review was performed to assess the success rate, recurrences and complications of the procedure.

During a mean follow-up period of 26.2 months (range, 12–53 months), 5 patients died during the study period. Two eyelids (3%) of one patient had a recurrence at 34 months postoperatively. One eyelid (1.5%) with a significant horizontal laxity developed postoperative ectropion and required a secondary horizontal shortening procedure. No other postoperative complications or dissatisfaction were reported. The retractor redirection procedure aims to repair the retractors and prevent orbicularis muscle overriding via inserting the retractors to the anterior lamellae. It yields a long-term success rate of 95.5% and is an effective technique for correcting involutional entropion.     

“The influence of orbital vector on involutional entropion and ectropion”

Purpose: This study aimed to evaluate the effect of orbital vector and other biometric parameters (i.e. axial globe length, axial globe projection) on the development of involutional entropion or ectropion.

Methods: In this cross-sectional study, 167 eyes from 132 patients were included. Of these eyes, 128 had involutional entropion and 39 had involutional ectropion, all of lower lids. The axial globe projection was measured using Hertel exophthalmometry; axial globe length was assessed by A-mode ultrasound; and orbital vector was determined clinically. Patient-specific categorical variables and continuous variables were compared using the chi-square test and the two-sided t test, respectively. Correlations were derived using the Pearson correlation.

Results: The percentage of females was 59% and 33.3% in the entropion group and in the ectropion group, respectively. A significant association was found between the gender and type of eyelid malposition (p = 0.015). Exophthalmometry reading was greater in the ectropion group than in the entropion group (17.7 ± 2.5 versus 10.8 ± 3.7 mm, respectively; p < 0.001). There was no significant correlation between axial globe length and exophthalmometry reading. Positive orbital vectors were observed in 87.5% of eyelids with involutional entropion. Negative orbital vectors were observed in 92.3% of eyelids with involutional ectropion (p < 0.001). Patients with negative orbital vectors showed greater axial globe projection than patients with positive orbital vectors (18.0 ± 2.1 versus 10.6 ± 3.5 mm, respectively; p < 0.001).

Conclusions: There is an association between orbital vector measurement and involutional entropion and ectropion. Measuring the orbital vector may help predict the development of these lid malpositions.     

下睑缩肌复位联合外侧睑板条固定术治疗退行性下睑内翻

目的：探讨并比较下睑缩肌复位联合外侧睑板条固定术及单纯下睑缩肌复位术治疗退行性下睑内翻的有效性和安全性。

方法：本研究为前瞻性研究。选取2015-01/2018-02在我科接受手术治疗的退行性下睑内翻患者79例91眼,随机分为观察组(41例46眼,行下睑缩肌复位联合外侧睑板条固定术)和对照组(38例45眼,行单纯下睑缩肌复位术),对两组临床疗效、术后并发症发生率进行比较。

结果：术后3mo随访,两组患者治愈率无差异(100% vs 98%,P=0.495)。术后24mo随访,观察组治愈率高于对照组(98% vs 84%,P=0.030)。观察组无术后并发症发生,明显少于对照组(11%,P=0.026)。

结论：下睑缩肌复位联合外侧睑板条固定术治疗退行性下睑内翻较单纯下睑缩肌复位术远期治疗效果佳,并发症少。     

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。     

Lateral tarsal strip plus skin-muscle flap excision in the treatment of lower eyelid involutional entropion

This article examines the effectiveness of skin-muscle flap excision in conjunction with a lateral tarsal strip for the treatment of involutional entropion. Ninety-six eyelids in 83 consecutive patients with involutional entropion were treated using a standardized surgical procedure. All patients underwent lower eyelid tightening with a lateral tarsal strip, dissection of a skin-muscle flap inferiorly through a subciliary incision and excision of redundant skin as well as orbicularis muscle. Follow-up data was obtained by retrospective chart review and telephone interviews. 80 patients were included in this study. The only exclusion criteria was failure to attend the 1 week follow-up appointment, n = 3. There was only one recurrence which was mild and revised under local anesthesia. Two patients had overcorrection with mild ectropion but did not require additional surgery. In those that completed their initial post-operative visit, the average time follow-up time was 502 days. Excision of a skin-muscle flap is a useful addition to lateral tarsal strip surgery in the treatment of involutional entropion and is a quick procedure producing excellent functional and cosmetic results. To our knowledge, this is the first cohort of patients to be reported using this technique where all patients had a standardized surgical approach. Additional studies are needed to compare long-term outcomes of this technique against other surgical treatments.     

Full-thickness lid sutures for entropion

Insertion of full-thickness absorbable eyelid sutures was carried out during a four-year period on 34 unselected patients with spastic or senile entropion. Four 5/0 Dexon sutures proved to be the most effective method. The over-all success rate was 50% and thus the operation cannot be recommended as the standard procedure for cases of entropion. Even so, it is useful in cases of spastic entropion due to surgery or corneal ulceration, when 100% success can be expected, and also when minimal surgical trauma or inconvenience is desired for often very elderly patients.     

睑内翻及倒睫的手术治疗

目的 研究内翻倒睫的手术方法。方法 回顾分析了自行设计的手术558例(775眼)。结果 手术治愈率94％，未出现并发症。结论 设计的手术方法简单易行，安全有效。     

Involutional entropion and ectropion

Entropion and ectropion are very common among old people. These malpositions concern mostly the lower lids. Involutional entropion and ectropion have some pathophysiologic mechanisms in common: lower lid horizontal laxity and lid retractor detachment. However, orbicularis muscle hypertrophy occurs only in entropion, and excess of posterior lamella has to be considered in ectropion. Clinical examination will guide surgical treatment. The authors present the main surgical procedures according to clinical findings. The goal is to prevent recurrence.     

Surgical correction of involutional lower lid entropion with lateral canthal eyelid block excision and imbrication of the capsulopalpebral ligament using non-buried non-resorbable imbricating sutures versus buried resorbable imbricating sutures

Purpose: To compare the results of surgical correction of involutional lower eyelid entropion using either buried resorbable imbricating sutures or non-buried non-resorbable sutures that were removed after five to seven days.

Methods: Retrospective analysis of a two-surgeon series. Analysis of the charts of patients surgically treated for involutional lower eyelid entropion between January 2011 and December 2014 with a minimum follow-up of 12 months. Main outcome measures: Recurrence rate, postoperative complications.

Results: We included 281 eyelids of 240 patients. Of these, 89 eyelids had been treated with buried resorbable imbricating sutures (surgeon WvdB) and 192 with non-buried non-resorbable sutures (surgeon DP). Of the 281 eyelids, 77 eyelids had undergone previous entropion surgery.

In the buried resorbable suture group (group R), the mean follow-up was 30 months (range 12 to 61 months) versus 39 months (range 14 to 60 months) in the non-buried non-resorbable group (group NR) (p = 0.07). With a follow-up of up to 18 months, the recurrence rate was 2.2% in group R and 4.2% in group NR (p = 0.73). With a similar follow-up, the recurrence rate was 3.9% after primary surgery versus 2.6% in recurrent cases (p = 0.73). Minor postoperative complications and side-effects were seen in 5.3% (15/281).

Conclusion: We found no difference in the recurrence rate between the use of buried resorbable imbricating sutures and non-buried non-resorbable sutures and between primary versus recurrent cases. We conclude that we can safely use buried resorbable imbricating sutures in involutional entropion. It yields comparable results and omits the need for suture removal.     

瘢痕性睑外翻的手术矫正

目的探讨瘢痕性睑外翻手术矫正的临床疗效。方法采用眼睑瘢痕切除、睑缘延长量楔形切除及游离植皮的方法,对23例（43眼）因瘢痕性睑外翻进行手术矫治,并观察其临床效果。结果本组伤后1～2个月手术5例（9眼）,〉6个月手术17例（32眼）,术后植皮成活良好,3例（3眼）于手术后1个月发生轻度睑裂闭合不全,无睑缘外翻,未处理;2例（2眼）于2个月后因面部瘢痕挛缩致使睑外翻,需再次手术处理;余经6个月～4年随访,效果良好。结论根据眼睑皮肤缺损大小,睑缘延长量多少设计手术方法,取耳后、锁骨上窝或上臂内侧全厚皮片、游离皮片修复睑皮肤缺损,效果良好。     

先天性葡萄膜外翻

先天性葡萄膜外翻是一种罕见的眼科疾病,以虹膜基质前表面存在虹膜色素上皮、房角发育异常、进行性青光眼为特征.一般为非进行性,最主要的并发症是发展为先天性或青少年型青光眼.此病与神经嵴发育异常相关,可与某些遗传病伴发.较为特殊的临床表现是环绕瞳孔的虹膜色素膜样外翻,终止于虹膜的中周部.边界清晰,外翻的程度各方向不尽相同.几乎所有患者在确诊后都行滤过性手术治疗.