外伤性眼睑退缩的手术治疗

目的：探索采用异体巩膜移植行眼睑退缩矫正手术的疗效。方法：自上睑板上缘切断上睑提肌腱膜,或自下睑板下缘切断下睑缩肌,充分分离后使上下睑缘位置恢复正常,在上述腿膜与睑板之间植入 体巩膜片,以使上睑提肌腱膜或下睑缩肌延长。结果：本组18例22只眼,除1例轻度轿正不足和1例发生轻度上睑下垂体,其余均获得成功。结论：采用异体巩膜移植延长上睑提肌腱膜或下睑缩肌,是修复外伤或手术后眼睑退缩的有效手术方法。     

Lateral canthoplasty--10-year experience

Lateral canthoplasty is a useful method to restore eyelid function and to protect the ocular surfaces. The success of the procedure depends on the proper analysis of periorbital anatomy as it relates to the specific indication for lateral canthoplasty. We report the experience with 129 lateral canthoplasties with emphasis on the evaluation of newer techniques that better address anatomic and functional requirements. Between 1994 and 2004, 129 lateral canthoplasties were performed in 105 patients, only for reconstructive purpose. A variety of surgical techniques have been described for lateral canthoplasty, and the evolution of the operative technique for lateral canthoplasty has been toward an operation that corresponds with the anatomy of the individual. Indications for the procedure include senile ectropion, tumors, cicatritial retraction, trauma, entropion, and congenital cleft. The evaluation of the newer procedures of lateral canthoplasty as unique reconstructive tools will be discussed.     

Prosthetics in Hernia Repair

This review examines the types of material used in hernia repair over the last 50 years and the evolvement of surgical repair techniques. The rates of infection and recurrence associated with past and present materials are also evaluated. In conclusion, while newer materials are associated with fewer complications, close attention to surgical technique is the single most important factor in hernia repair.     

悬吊下睑板法辅助修复下睑外翻或退缩

目的探讨应用悬吊下睑睑板治疗各种下睑外翻或退缩的方法和疗效。方法对轻度下睑外翻或退缩采用尼龙线在一侧固定于内眦韧带后,向外侧“蛇形”缠绕下睑板,外侧端固定于外眦韧带外上方处悬吊下睑组织的方法修复;对重度下睑外翻或退缩,采用掌长肌腱游离移植辅助治疗瘢痕性下睑外翻的方法,下睑继发创面直接缝合或局部皮瓣转移修复。结果自2009年5月至2013年9月,共修复各种下睑外翻或退缩15例,其中轻度下睑外翻或退缩8例,重度下睑外翻或退缩7例;所有患者术后下睑外翻均得到矫正,随访6～36个月,均无睑外翻或退缩复发。结论根据患者下睑外翻或退缩的情况,采用合适的悬吊下睑板的方法辅助治疗下睑外翻或退缩,可取得较好的修复效果。     

Augmentation blepharoplasty

Conventional lower lid blepharoplasty techniques emphasize the removal of excess skin and fatty bulges of the lower eyelid. The appearance is improved at the expense of lateral pretarsal flatness associated with the senile eyelid. Augmentation blepharoplasty is a modified technique for a lower lid blepharoplasty using an overlapping orbicularis oculi muscle repair to increase pretarsal fullness, which is associated with the youthful lower eyelid. The technique was used successfully in 30 consecutive, unselected patients, and this experience is reviewed in detail. The technique, surgical anatomy, and complications are outlined. The results prove this technique to be a safe method of lower lid blepharoplasty that does not interfere with the additional goals of periorbital fat and excess skin removal.     

Midfacial rejuvenation

The midface is an important new area in facial rejuvenation. Rejuvenation of the midface is necessary to achieve harmonious rejuvenation of the face. The extent of "lift" to be achieved with midfacial elevation is very limited. Excessive elevation of midfacial tissues results in vertical shortening of the lower eyelid, round eye deformity, and ectropion. In patients with previous blepharoplasty or midfacelifts, minimal or no tissue can be resected. Instead, any midfacial advancement achieved is required to reconstruct the lower eyelid form and allow a canthoplasty or canthopexy to heal without undue downward traction on the repair. The surgeon must elevate the midface tissue in a very limited, safe fashion. Many current approaches to midfacial rejuvenation exist in a number of anatomic planes, with several fixation techniques. Some surgical approaches, such as surgery in a suborbicularis plane, may be inherently safer than others. Aesthetic micromanagement of the lower eyelid position and orbicularis muscle is possible. A useful test for assessing the amount of available midfacial tissue is provided.     

The correction of lower eyelid retraction with ectropion due to gravity with auricular cartilage —suspension of lower eyelid with cartilage sling

Summary There are many surgical treatments for lower lid ectropion, but very few are effective for lower eyelid retraction with ectropion because of the influence of gravity on the flap transferred to the cheek. In two cases, we have successfully treated lower lid ectropion by suspending the lower lid with the ear cartilage taken from the antihelix. We believe that ear cartilage taken from the antihelix is a suitable material to suspend the lower eyelid for correction of lower eyelid retraction with ectropion due to gravity acting on the flap.     

不同程度下睑退缩的手术治疗

目的 探讨不同程度下睑退缩的有效矫正方法.方法 对1999年以来收治的258例下睑退缩的患者,按退缩程度采用不同的手术方法进行矫正.①轻度:150例,外眦锚着术;②中度:80例,联合外眦锚着术和Hamra的保留眶脂肪的睑成形术;③莺度:28例,联合外眦锚着术和经下睑成形术切口的颊提升术.98例患者获术后3～12个月随访,比较术后效果,总结不同程度下睑退缩的矫正方法.结果 本组258例患者,98例获得3～12个月随访,其中,轻度51例,中度29例,重度18例.91例患者下睑退缩完全矫正,睁眼时下睑恢复至正常位置(即下睑缘位于角膜下缘,无巩膜显露),睑裂能完全闭合,外眦角变锐,瘢痕不明显.3例中度和4例重度患者下睑退缩矫正不全,即睁眼时角膜下缘仍有巩膜显露,睑裂闭合不全,但较术前有明显改善.其他并发症包括淤斑、球结膜水肿、睑球分离等.结论 根据下睑退缩的程度选择适宜的手术方法,可以有效矫正下睑退缩.     

不同程度下睑退缩的手术治疗

目的 探讨不同程度下睑退缩的有效矫正方法.方法 对1999年以来收治的258例下睑退缩的患者,按退缩程度采用不同的手术方法进行矫正.①轻度:150例,外眦锚着术;②中度:80例,联合外眦锚着术和Hamra的保留眶脂肪的睑成形术;③莺度:28例,联合外眦锚着术和经下睑成形术切口的颊提升术.98例患者获术后3～12个月随访,比较术后效果,总结不同程度下睑退缩的矫正方法.结果 本组258例患者,98例获得3～12个月随访,其中,轻度51例,中度29例,重度18例.91例患者下睑退缩完全矫正,睁眼时下睑恢复至正常位置(即下睑缘位于角膜下缘,无巩膜显露),睑裂能完全闭合,外眦角变锐,瘢痕不明显.3例中度和4例重度患者下睑退缩矫正不全,即睁眼时角膜下缘仍有巩膜显露,睑裂闭合不全,但较术前有明显改善.其他并发症包括淤斑、球结膜水肿、睑球分离等.结论 根据下睑退缩的程度选择适宜的手术方法,可以有效矫正下睑退缩.     

不同程度下睑退缩的手术治疗

目的 探讨不同程度下睑退缩的有效矫正方法.方法 对1999年以来收治的258例下睑退缩的患者,按退缩程度采用不同的手术方法进行矫正.①轻度:150例,外眦锚着术;②中度:80例,联合外眦锚着术和Hamra的保留眶脂肪的睑成形术;③莺度:28例,联合外眦锚着术和经下睑成形术切口的颊提升术.98例患者获术后3～12个月随访,比较术后效果,总结不同程度下睑退缩的矫正方法.结果 本组258例患者,98例获得3～12个月随访,其中,轻度51例,中度29例,重度18例.91例患者下睑退缩完全矫正,睁眼时下睑恢复至正常位置(即下睑缘位于角膜下缘,无巩膜显露),睑裂能完全闭合,外眦角变锐,瘢痕不明显.3例中度和4例重度患者下睑退缩矫正不全,即睁眼时角膜下缘仍有巩膜显露,睑裂闭合不全,但较术前有明显改善.其他并发症包括淤斑、球结膜水肿、睑球分离等.结论 根据下睑退缩的程度选择适宜的手术方法,可以有效矫正下睑退缩.     

睑板提紧术防治下睑袋整形术后睑退缩及外翻

目的为了预防和降低下睑袋整形术后睑退缩和睑外翻等并发症的发生。方法我们自1991年以来,采用睑板提紧术(The tarsal tuck procedure)的方法。结果可以拉紧及稳定下睑,取得了预期的效果。结论大多数睑袋(除原发性睑袋外)发生的病理解剖基础是下睑支持结构的退行性变,致下睑及外眦松弛下移,这是造成术后睑退缩和睑外翻的基本潜伏因素。通过临床实践,我们认为睑板提紧术是针对这一病理改变所进行的手术设计,确认可靠有效,值得推广。     

睑板提紧术防治下睑袋整形术后睑退缩及外翻

目的为了预防和降低下睑袋整形术后睑退缩和睑外翻等并发症的发生。方法我们自１９９１年以来,采用睑板提紧术（Ｔｈｅｔａｒｓａｌｔｕｃｋｐｒｏｃｅｄｕｒｅ）的方法。结果可以拉紧及稳定下睑,取得了预期的效果。结论大多数睑袋（除原发性睑袋外）发生的病理解剖基础是下睑支持结构的退行性变,致下睑及外眦松弛下移,这是造成术后睑退缩和睑外翻的基本潜伏因素。通过临床实践,我们认为睑板提紧术是针对这一病理改变所进行的手术设计,确认可靠有效,值得推广。     

睑板提紧术防治下睑袋整形术后睑退缩及外翻

目的 为了预防和降低下睑袋整形术后睑退缩和睑外翻等并发症的发生。方法 我们自１９９１年以来，采用睑板提紧术（Ｔｈｅ ｔａｒｓａｌ ｔｕｃｋ ｐｒｏｃｅｄｕｒｅ）的方法。结果 可以拉紧及稳定下睑，取得了预期的效果。结论 大多数睑袋（除原发性睑袋外）发生的病理解剖基础是下睑支持结构的退行性变，致下睑及外此松弛下移，这是造成术后睑退缩和睑外翻的的基本潜伏因素。通过临床实践，我们认为睑板提紧术是针对这一病     

Lower eyelid retraction: a minimal incision surgical approach to retractor lysis

Lower eyelid retraction associated with prior blepharoplasty, trauma, or other conditions is a challenging problem for the ophthalmic surgeon. We describe a procedure involving tightening the lower eyelid and supraplacing the lateral canthus in combination with in-glove lysis of the lower eyelid retractors and scar tissue. This is accomplished through a small lateral incision. To date, we have treated over 200 eyelids using this technique with excellent results. We recommend this technique for the treatment of mild to moderate degrees of lower eyelid retraction.     

Refining the goals of oculofacial rejuvenation with dynamic ultrasonography

Volume enhancement/restoration addresses a key component of facial aging and plays an increasingly central role in facial rejuvenation. Advancing our understanding of the structure and morphology of facial aging-and the changes that can be induced with currently-available fillers-will optimize treatment and provide a consensus for appropriate selection of agents and procedures. By elucidating anatomic relationships-particularly dynamic relationships-ultrasonography may facilitate the selection and application of rejuvenation agents and procedures such as lower eyelid blepharoplasty with hyaluronic acid reinforcement of the middle lamella and lateral canthal retinaculum, en glove lysis and dermal fat grafting in the retractor plane for lower eyelid retraction, "posterior girdle" effect with high-viscosity fillers for malar festoons, dynamic analysis of hyaluronic acid within the levator plane for upper eyelid retraction, and serial distribution and integration of autologous fat injection in the lower lid compartments. In this article, the authors describe use of dynamic high-resolution ultrasonography as a tool in defining and improving the outcomes of periocular facial rejuvenation.     

Tratamiento perioperatorio para la cirugía urgente de descompresión orbitaria en una paciente gestante de 30 semanas con orbitopatía de Graves

Thyroid ophthalmopathy is a rare extra-thyroid complication usually associated with Graves’ disease. This disease can occur in the euthyroid pregnant patient. Graves’ orbitopathy is characterized by eyelid retraction, proptosis, extraocular muscle dysfunction, and periorbital edema. In some cases an emergency surgical repair may be required to avoid irreversible vision loss.We present the case of a 35-year-old woman in her 30th gestational week, who suffered from Graves’ ophthalmopathy, severe exophthalmia, and visual acuity decrease. Following consultations among anesthesiologists, ophthalmologists, maxillofacial surgeons, endocrinologists, obstetricians and the patient, it was decided to perform a surgical orbital wall decompression.The anesthetic and perioperative implications associated with gestational age and the considerations for this surgical procedure, and how to avoid increasing intraocular pressure are discussed.     

A novel technique for repositioning lower eyelid fat via the transoral approach in association with midface lift

Background  

Orbital fat repositioning in association with subperiosteal midface elevation has been variably described via both the transconjunctival and skin muscle flap approaches. Poor visualization, middle and posterior lamellar cicatricial fibrosis, technical difficulty, and incomplete release are disadvantages commonly ascribed to the transconjunctival approach. Lower eyelid malposition and retraction also are commonly seen in association with skin muscle flap approaches. A simple technique using the intraoral approach to release the orbital septum and postseptal fat is described in this report. This procedure avoids complications associated with the violation of key lower eyelid anatomic structures and markedly improves visualization through an incision allowing a much larger access.     

外眦成形术在矫正下睑错位和下睑退缩的效果观察

目的:分析外眦成形术在矫正下睑错位和下睑退缩的效果。方法:选择在本院接受手术治疗的下睑错位和下睑退缩患者作为研究对象,分别给予常规手术治疗及外眦成形术治疗,比较两组患者的治疗后的下睑缘下移程度、负面情绪评分等差异。结果:观察组下移距离(0.98±0.21)mm、VAS评分(2.54±0.47)、HAMD评分(15.21±2.24)、HAMA评分(13.12±1.24)明显低于对照组(P0.05);轻度下移(84.78%)、躯体功能(87.21±13.32)、心理功能(79.42±10.47)、社会功能(81.46±11.21)、总体生活质量(95.24±14.57)均明显高于对照组(P0.05)。结论:外眦成形术可以有效减轻下睑错位和下睑退缩的病情,达到良好的校正效果,提高了生活质量。     

睑袋整复术后下睑退缩的矫正

目的：探讨矫正睑袋整复术后并发的下睑退缩的理想方法。方法：对5例（8只眼）下睑退缩较轻者，单纯施行经眦眦固定术缩紧外眦腱使下睑缘上移复位；对15例（27只眼）下睑退缩较重者，施行经眦紫固定术同时行Hamra释放弓状缘和保留眶脂肪的下睑成形术，以在缩紧外眦腱的同时松解下睑眶隔和眶脂肪层的瘢痕挛缩，悬吊眼轮匝肌及提升中面部皮肤补充下睑前层不足。结果：术后14例（25只眼）得到6－12个月的随访，除1例（1只眼）较重的下睑退缩矫正不全外，其余均获得满意效果。结果：①经眦眦固定术是矫正轻度下睑退缩简单而有效的方法；②施行经眦眦固定术同时行Hamra下睑成形术是矫正较重度下睑退缩的理想选择。     

Eyelid complications in trachoma. I. Cicatricial entropion

Trachoma is an infectious disease affecting the conjunctival membranes of the eye that results in scarring of the conjunctiva with secondary eyelid malformations and lacrimal pathology. Of the four eyelid complications secondary to trachoma--cicatricial entropion, eyelid retraction, secondary blepharospasm, and brow ptosis--by far, cicatricial entropion is the most common. One thousand two hundred patients with cicatricial entropion underwent surgery at the King Khaled Eye Specialist Hospital between 1984 and 1988. The classification and management of these cases are discussed, emphasizing the various surgical techniques used.