同种异体巩膜下睑缩肌延长术治疗甲状腺相关眼病下睑挛缩

目的:评估同种异体巩膜下睑缩肌延长术矫正甲状腺相关眼病下睑挛缩的临床疗效。方法:对12例16眼以下睑挛缩为主要表现的静止期的甲状腺相关眼病患者,采用同种异体巩膜下睑缩肌延长术矫正挛缩的下睑,并观察其临床疗效。结果:术后所有患者睑裂高度均明显下降,自觉症状不同程度减轻或消失。术后普遍存在的并发症是眼睑肿胀,且持续时间长。结论:同种异体巩膜下睑缩肌延长术能有效矫正甲状腺相关眼病的中重度下睑挛缩。     

异体巩膜矫正甲状腺相关眼病上睑退缩并内翻

目的 评估异体巩膜移植延长上睑提肌矫正甲状腺相关眼病上睑退缩并内翻的疗效.方法 对17例（21眼）上睑退缩并内翻的静止期甲状腺相关眼病患者行异体巩膜移植延长上睑提肌矫正上睑退缩并内翻,观察其临床效果.结果 术后所有患者睑裂宽度均较术前缩小,差异有统计学意义（t=2.94,P=0.028）,患者自觉症状不同程度减轻或消失,随访6个月和1年无上睑退缩或内翻复发.结论 异体巩膜移植延长上睑提肌能有效矫正甲状腺相关眼病上睑退缩并内翻.     

提上睑肌中央腱膜切断术治疗甲状腺相关眼病上睑退缩

目的：评估提上睑肌中央腱膜切断术矫正甲状腺相关眼病上睑退缩的临床疗效。方法：对35例52眼以上睑退缩为主要表现的静止期甲状腺相关眼病患者采用提上睑肌中央腱膜切断术矫正退缩的上睑,并观察其临床疗效。结果：术后所有患者上睑退缩均得以矫正,自觉症状不同程度减轻或消失。结论：提上睑肌中央腱膜切断术能有效矫正甲状腺相关眼病的中度上睑退缩。     

下直肌后退联合下睑筋膜头分离复位在甲状腺相关眼病患者斜视矫正术的应用

目的探讨甲状腺相关眼病患者下直肌后退术中下睑退缩的防治措施。方法 回顾性病例研究。广州中山大学中山眼科中心2007年1月至2011年12月行下直肌后退术的甲状腺相关眼病患者24例,其中男18例,女6例;平均年龄（47.8±10.7）岁。甲状腺相关眼病患者下直肌后退术中除充分分离下直肌与下睑的联系外,同时将与下直肌相联的下睑筋膜头分离并标记,下直肌后退后将下睑筋膜头缝回到下直肌原肌止点处。结果 下直肌后退量2.5～8.0 mm,平均为（5.31±1.16）mm,仅5例在术后出现轻度的下睑退缩,术后下睑位置总量改变为0。2例患者显示下方巩膜暴露,但睑裂大小无改变。所有患者术后无下睑其他外观改变。结论 下直肌后退术中充分分离下睑与下直肌的联系,同时分离下睑筋膜头并缝回到下直肌原肌止点处可有效防治甲状腺相关眼病患者下直肌后退术后的下睑退缩。     

Medpor下睑插片与异体巩膜植入治疗下睑退缩

目的:探讨Medpor下睑插片和异体巩膜植入在治疗下睑退缩患者中的临床治疗效果。 方法:对26例下睑退缩患者行Medpor下睑插片或异体巩膜移植矫正下睑退缩,随访3mo,观察手术治疗效果。 结果:手术治疗后3mo,Medpor下睑插片和异体巩膜植入各有1例欠矫,其余24例下睑退缩均成功矫正,眼睑闭合正常,下睑缘位置正常,无巩膜暴露。所有病例均无感染、排斥及其它并发症。 结论:Medpor下睑插片或异体巩膜植入都能有效地矫正大多数患者的下睑退缩,手术安全性好,治疗效果较好。两者在手术效果上相比没有明显的差别。     

Grave眼病下睑退缩并内翻倒睫的手术治疗

目的 探讨Grave眼病下睑退缩并睑内翻倒睫的最佳手术方式,并避免术后复发.方法 对确诊Grave眼病下睑退缩并内反倒睫的患者手术治疗.从下睑缘下1.5 mm处作皮肤切口,沿下睑板下缘切断下睑缩肌与睑板肌复合体,充分游离后,在下睑板下缘与复合体间填充一条同种异体巩膜片,然后缝合皮肤创口.结果 治疗初诊患者16例,外院复发患者5例,其中男性4例,女性17例,年龄18～60岁,单侧5例,双侧16例.手术后经3～46个月观察,下睑位置恢复正常,未见复发病例.结论 此手术不仅松解了处于兴奋状态的睑板肌,更主要的是阻断了交感神经对睑板肌的作用.不仅近期疗效好,也预防了疾病复发.是治疗Grave眼病下睑退缩并睑内翻倒睫的一种较好手术方法.     

下睑缩肌切除术治疗轻中度下睑退缩的临床研究

目的:研究下睑缩肌切除术在治疗轻中度下睑退缩中应用的可行性。方法:选择自2007-04/2010-12到我院整形门诊就诊的轻中度下睑退缩患者16例24眼,均在局部麻醉下行下睑缩肌切除术。随访6～18(平均8.9)mo。结果:所有患者术后下睑退缩均得到矫正,矫正量1.0～3.0(平均2.5)mm。结论:下睑缩肌切除术对于治疗轻中度下睑退缩是一种理想的手术方法,值得在临床上推广应用。     

先天性下睑退缩合并睑内翻的手术治疗

目的探讨先天性下睑退缩合并睑内翻的治疗方法。方法距下睑缘1．5mm做皮肤切口,分离下睑缩肌,取与睑板相应长度的巩膜条,高度为下睑退缩量＋2mm,分别缝合于睑板下缘与下睑缩肌之间,缝合皮肤。术后1周、1个月及6个月观察下睑缘位置。结果17例（21只眼）随访2—20个月,平均（6．1±4．5）个月。18只眼治愈,另3眼于术后6个月残存下睑退缩约1mm,此3眼均为术前下睑退缩5mm者,半年后再次手术后治愈。结论下睑缩肌切断联合异体巩膜条植入对于治疗轻中度先天性下睑退缩合并内翻倒睫是较好的方法。     

高密度多孔聚乙烯下睑植片在下睑退缩中的应用

目的评估高密度多孔聚乙烯下睑植片矫正下睑退缩的安全性和有效性。方法回顾性分析了2003年10月至2005年10月间下睑退缩病人。其中,年龄18岁～82岁,平均40岁。术前及术后检查包括下方巩膜暴露量及眼睑闭合不全情况。所有病人均行下睑缩肌切断加多孔聚乙烯下睑植片植入。结果随访时间4m～28m,所有病人下睑退缩基本矫正。下睑巩膜暴露量术前平均为2.92mm(2～6mm),术后平均为0.12mm(-1～2mm),p<0.001;眼睑闭合不全术前25眼,术后9眼。2眼植片暴露,经修补后痊愈。结论多孔聚乙烯下睑植片作为人工合成的下睑填充物,具有足够的硬度、组织相容性好,能有效地矫正下睑退缩。     

甲状腺相关眼病限制性斜视手术并发症的临床分析

目的:总结甲状腺相关眼病(thyroid associate dophthalmopathy,TAO)导致的限制性斜视手术并发症的常见原因及应对策略。方法:回顾性分析于2009-01/2012-02在我院就诊的21例眼外肌手术出现并发症的TAO限制性斜视病例,分析手术前病情、手术情况、手术并发症等临床资料。结果:患者21例中术前有6例为限制性上斜视,15例为限制性下斜视。手术中行上直肌断腱1例,后退5例,下直肌后退15例。术中发生巩膜损伤2例,其中1例在断肌止点时损伤巩膜,1例在将肌肉固定于巩膜上时缝穿巩膜;术中预置缝线滑脱3例;术后早期(术后1mo内)发生欠矫6例,过矫5例;术后晚期(术后6mo后)出现过矫15例,包括6例限制性上斜视患者、9例限制性下斜视;下睑退缩8例。结论:TAO限制性斜视手术矫正容易出现过矫,手术中应严格控制肌肉后退量,下直肌后退时应注意下睑退缩发生的可能。     

Correction of lower eyelid retraction with a porous polyethylene (Medpor) lower eyelid spacer--Medpor spacer in lower eyelid retraction

BACKGROUND: The correction of lower eyelid retraction remains a challenge with established techniques having disadvantages. A recently described alternative is implantation of an ultrathin high density porous polyethylene lower eyelid spacer (Medpor LES). We report our experience on implanting this Medpor LES, especially in patients with lower eyelid retraction due to Graves' orbitopathy. PATIENTS AND METHODS: All patients receiving a Medpor LES between March 2003 and November 2004 in the Rotterdam Eye Hospital were included. Indications and preceding procedures as well as the degree of proptosis were noted. Preoperative and postoperative lower eyelid retraction were compared by measuring scleral show inferior to the limbus (LSS). Postoperative complications, recurrent retraction and secondary surgical procedures were recorded. RESULTS: Out of 12 patients (16 eyelids) in whom a Medpor LES was inserted 8 patients suffered from Graves' orbitopathy. Mean follow-up was 7.5 months (range 4 - 11 months). Final cosmetic outcome was good in 8/16 eyelids and improved in 7/16 eyelids. Lower eyelid retraction (LSS) was reduced significantly (1.34 mm +/- 0.214 (mean +/- std. error of mean), p = 0.004). Complications included eyelid contour deformity (4/16 eyelids), remaining irritation of the eye (1/16) and problems in down gaze (4/16) as well as recurrent lower eyelid retraction (2/16) requiring further surgery in 3 of 11 patients. CONCLUSIONS: In selected patients, insertion of a Medpor lower eyelid spacer may be a good alternative to correct lower eyelid retraction.     

Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic Acid gel

PURPOSE: To report our preliminary experience utilizing a nonsurgical alternative in the treatment of lower eyelid retraction: expansion and reinforcement of the lower eyelid with hyaluronic acid gel. METHODS: Retrospective review of patients with lower eyelid retraction treated with hyaluronic acid gel. Pretreatment, post-treatment, and follow-up photographs were digitized and overall outcomes assessed. Measurements of inferior scleral show were standardized and compared. RESULTS: Sixty-five procedures (31 patients; 14 male; mean age 58 years, range, 33-78 years) with lower eyelid retraction of various etiologies were treated with hyaluronic acid gel. A mean change in scleral show of 1.04 mm was found when pre- and post-treatment measurements were compared. The overall mean follow-up period was 6.2 months (range, 1-12 months). During the interval from initial treatment to follow-up visit (mean 4.6 months, range, 1-12 months), the effect of the hyaluronic acid gel diminished, with a mean increase in inferior scleral show of 0.52 mm. Twelve patients underwent a second, and 6 patients underwent a third, maintenance treatment with an improvement in scleral show of 0.87 mm and 1.13 mm, respectively. Complications were minor and included swelling, redness, bruising, and tenderness at the sites of injection. CONCLUSIONS: Based on our preliminary results, hyaluronic acid gel shows promise as a treatment modality for the management of lower eyelid retraction. Long-term follow-up will better clarify the required frequency of maintenance injections, the degree of hyaluronic acid gel retention, and the position of the lower eyelid over time.     

探讨Medpor下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻

目的　探讨Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻的临床疗效。方法　回顾性系列病例研究。收集１６例（１６眼）重度麻痹性下睑外翻患者的临床资料,所有患者均采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗。记录并比较１６例患者术前及术后１周、３个月、１２个月的眼睑闭合不全量、下睑退缩量、角膜上皮分级、下睑水平及垂直松弛度等级。结果　１６例患者术后下睑外翻均矫正,随访期内均未见复发。术后１周、３个月、１２个月,下睑退缩量、眼睑闭合不全量均较术前明显下降,差异均有统计学意义（均为Ｐ＜０．０５）;术后各时间点间比较,差异均无统计学意义（均为Ｐ＞０．０５）。随访期间各患者的角膜上皮分级、水平及垂直松弛度等级均较术前明显改善,随访期末均为０级或１级。无１例患者术后出现眶内出血、感染及内植入物暴露、排斥、移位等严重并发症。结论　采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻,可在保留患者视功能的前提下矫正下睑外翻及眼睑闭合不全,有效改善患者眼表状况及外观,且术后效果较为稳定。     

经结膜下睑缩肌折叠联合外眦睑板条固定矫正退行性下睑外翻的疗效观察

目的 探讨经结膜下睑缩肌折叠联合外眦睑板条固定术治疗退行性下睑外翻的效果。设计回顾性病例系列。研究对象北京同仁医院眼科退行性下睑外翻患者13例(13眼)。方法 回顾患者的病历资料。所有患眼均采用经结膜入路,将下睑缩肌折叠缝合于睑板下缘;联合外眦睑板条固定。术后平均随访时间(7.1±2.5)个月。主要指标眼睑形态、睑缘位置、眼睑水平及垂直松弛度。结果 最后随访时所有患者下睑外翻得到矫正,患者外观及症状明显改善。外翻程度从术前的Ⅱ～Ⅳ级降至术后为0～Ⅰ级(Z=-4.652,P<0.0001)。术前下睑垂直松弛度为(7.04±0.52)mm,最后随访时为(4.31±0.51)mm(t=22.45,P<0.0001)。术前水平松弛度为(9.5±0.91)mm,最后随访时为(5.19±0.52)mm(t=19.96,P<0.0001)。所有患者未发生过矫、复发、缝线脓肿、伤口异常或下穹窿变浅。结论 本小样本量研究结果 显示,经结膜折叠下睑缩肌联合外眦睑板条固定术是矫正退行性下睑外翻的简单有效方法 。(眼科,2022,31:315-318)     

Congenital entropion with intact lower eyelid retractor insertion

Congenital lower eyelid entropion is generally considered to result from improper development of the retractor aponeurosis insertion to the inferior portion of the tarsal plate. We treated three patients with this uncommon disorder. At operation, aponeurotic defects were anticipated and specifically sought, but in each case the lower eyelid retractors were inserted normally. In two patients, entropion was relieved by surgical disinsertion and then advancement of the retractors. In the third patient, who also had multiple concomitant facial and systemic developmental anomalies, improvement in the lower eyelid malpositions required a combination of procedures. The intraoperative findings in our patients demonstrate that disinsertion of the lower eyelid retractors is not a universal etiologic mechanism in congenital entropion.