儿童眼球突出继发下睑退缩的手术探讨

目的 探讨儿童眼球突出继发下睑退缩的手术方式和效果.设计回顾性病例系列.研究对象北京儿童医院不同原因所致眼球突出合并下睑退缩、内翻倒睫患儿8例(14眼),年龄1岁3个月～8岁4个月.方法 所有病例采用下睑缩肌后徙联合睑板内固定术.术后随访6～12个月.主要指标术前术后下睑缘中央至瞳孔反光点距离(MRD2)、下睑内翻倒睫...     

应用异体巩膜治疗甲状腺相关眼病下睑退缩

目的 评估应用异体巩膜延长下睑缩肌矫正甲状腺相关眼病下睑退缩的临床疗效.方法 对15例(25眼)以下睑挛缩为主要表现的静止期甲状腺相关眼病患者,采取异体巩膜延长下睑缩肌术矫正退缩的下睑,并观察其临床疗效 .结果 术后患者自觉症状均不同程度减轻或消失,术后所有患者睑裂宽度与术前比差异均有统计学意义(P＜0.01),术后6月、1年随访无眼睑退缩复发.结论 异体巩膜下睑缩肌延长术能有效矫正甲状腺相关眼病下睑退缩.     

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。     

按重睑线切开行内翻倒睫术

对于上睑瘢痕性睑内翻倒睫的病人 ,临床上常用手术方法为睑板部分切除法 (Ｈｏｔｚ术 ) ,该法治疗倒睫疗效确切 ,不易复发 ,但存在矫正不足 ,睑缘外翻 ,变形等不足[1] 。作者根据倒睫形成的机制 ,改良Ｈｏｔｚ术 ,按美容的要求自重睑线切开 ,治疗 2 3例 ,术后随访 3～ 6月 ,倒睫全部得到矫正 ,重睑自然、美观 ,现报告如下。　　一般资料 :2 3例上睑内翻倒睫中 ,2 0例由沙眼或炎症所致 ,2例眼睑烫伤 ,1例碱烧伤 (共 31眼 ,其中单眼 15例 ,双眼 8例 )。男性 7例 ,女性 16例 ;年龄 2 4～ 5 8岁 ,平均 46 3岁。手术方法 :先按重睑画线标准由内向…     

Medpor下睑插片植入治疗下睑退缩

目的评价Medpor下睑插片作为下睑植入物治疗先天性及后天性下睑退缩的效果。设计回顾性病例系列研究。研究对象33例患者36眼，其中先天性下睑退缩4例6眼，后天性者29例30眼。方法术前测量在第一眼位下睑相对角膜下缘的位置及距下眶缘的位置。手术采用下睑袋皮肤切口，打开眶隔，视患者下睑退缩程度修剪Medpor下睑插片的形状及大小，将植入物置于下睑板下缘及眶下缘骨缘之间。术后观察植入物是否移位或脱出。术后2周及3个月时测量下睑位置，观察其变化情况。主要指标第一眼位下睑位置。结果对33例36眼行Medpor下睑插片植入者随访6～24个月，无植入物脱出及移位。34眼在第一眼位下睑位于角膜缘或角膜下缘上0．5mm，2眼仍残存≥1mm的下睑退缩。结论Medpor下睑插片作为植入物可提供下睑长期的支撑，可达到良好的功能及美容效果。Medpor下睑插片可作为治疗下睑退缩的较理想植入物。     

下睑缩肌后徙与切断手术治疗轻度下睑退缩

目的探讨下睑缩肌后徙或切断手术治疗轻度下睑退缩的临床效果。方法手术多在局麻下进行，采用经典的下睑袋皮肤切口。打开下眶隔，将眶脂肪向下推，暴露下睑缩肌的前表面，沿下睑板下缘处分离下睑缩肌，将下睑缩肌完全分离至下穹隆。于穹隆水平处切断或将其后徙缝合于下穹隆处结膜面。患者取坐位观察下睑位置，以下睑位于下方角膜缘上0．5mm为宜。术后1周、1月及6月测量下睑位置，观察其变化情况。结果11例（14眼），随访6—20月，平均7．3月，获良好效果。12眼在双眼平视时下睑位于角膜下缘，2眼仍残存下睑退缩约0．5mm。全部病例下睑退缩较术前有极大的改善，手术效果良好。结论下睑缩肌后徙或切断手术治疗轻度下睑退缩可获得较好的功能和美容效果。对于轻度下睑退缩的治疗是一种较理想的方法。     

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。     

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。     

睑缘切开带蒂轮匝肌瓣充填术治疗严重上睑内翻倒睫

目的 评价睑缘切开带蒂轮匝肌以填术治疗严重上睑内翻倒睫的临床疗效。方法 对我院门诊诊断严重上睑内翻倒睫病人１１１例１９７眼行睑缘灰带切开带蒂轮匝肌,瓣充填术;术后随访,观察术后２ｗｋ、６、１２及３６ｍｏ的疗效。结果 术后２ｗｋ带蒂轮匝肌瓣全部成活,睑缘上以长入肌瓣表面;术后６ｍｏ无复发病例,失记２例（３眼）;术后１２ｍｏ,复发２例（２眼）,失访９例（１７眼）,复发率１．１％,术后３６ｍｏ,复发５例     

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.     

甲状腺相关性眼病上睑退缩的手术治疗

目的探讨甲状腺相关性眼病（TAO）静止期上睑退缩的手术治疗方法。方法对30例（48眼）TAO静止期上睑退缩采用患眼Muller肌切除联合部分上睑提肌腱膜切断手术治疗。结果手术治疗后5天与6—9月显效率分别为85．42％和72．92％，疗效无显著差异（x^2=1．07，P〉0．25）。结论TAO静止期上睑退缩采用手术治疗效果显著而稳定，并发症少，是治疗静止期TAO上睑退缩的有效方法。     

下睑内翻和上睑肥厚性单睑及内眦赘皮一期手术观察

目的 探讨下睑内翻和上睑肥厚性单睑及内眦赘皮一期进行的手术方法和美容效果.方法 先进行睑裂横径和内眦间距的测量,根据测量值设计新内眦点,采用睫毛周边切口矫治内眦赘皮.平行上下睑缘剪开内眦赘皮达新内眦点,分离上下皮瓣与眼轮匝肌,将原内眦点的皮肤与新内眦点皮肤缝合.下睑睫毛下1.5 mm横贯切口与内眦皮瓣相连,分离皮肤达眶下缘,白睑缘下2 mm分出宽4 mm肌肉瓣,在近外眦处将其缩短3～4 mm,7-0尼龙线间断缝合皮肤.上睑沿重睑设计线切开,下唇分离至睫毛根部,剪除其下多余组织,上唇去除一窄条皮肤直达内眦皮瓣并将其多余处剪除,打开眶隔剪除脱出脂肪组织,中间挂提上睑肌腱膜后间断缝合皮肤.结果 本组16例32只眼,上、下睑内翻均得到矫正,重睑自然,睑裂明显变长开大,内眦赘皮消失.结论 采用此种联合手术方法做出的眼睛,不但治疗了疾病,而且达到了美容的目的,值的推广应用.     

两种方法矫正先天性下睑内翻的疗效观察

目的观察先天性下睑内翻倒睫深部固定联合灰线切开手术的疗效。方法将我院先天性下睑内翻倒睫手术病例按手术方式不同分A、B两组进行回顾性分析研究。A组71例（103只眼）行深部固定加灰线切开手术,B组26例（38只眼）仅作深部固定矫正,随访观察3～82个月,平均（20.5±19.5）个月,观察统计两组复发率。结果 A组复发0只眼,复发率0%,B组复发13只眼,复发率34.2%。经χ2检验分析,两组手术后复发率的差异（χ2=38.82,P〈0.005）具有统计学高度显著性意义。结论深部固定加灰线切开手术治疗先天性下睑内翻疗效好,复发少。     

内外双重连续缝合法矫正儿童下睑内翻的临床研究

目的 探讨一种新的治疗儿童下睑内翻的手术方法.方法 利用贺一杨针对贺忠江式内外双重连续缝合法进行改良,对36例重度下睑内翻儿童术后随访6～24个月.结果 治愈32例,占88.9%;好转4例,占11.1%;无欠矫、过矫等并发症.结论 改良的贺忠江式内外双重连续缝合法,安全、迅速、可调整、并发症少,是一种治疗儿童下睑内翻的好方法.     

Congenital lower eyelid deformity with trichiasis (epiblepharon and entropion)

A series of 43 patients with congenital lower eyelid malposition and trichiasis (epiblepharon and entropion) is presented with clinical findings, family history, approach to management and results of treatment. The average age of patients was 9.3 years. A family history was present in 21 %, and 30% had at least one parent of Oriental extraction. Thirty-nine patients underwent surgery for persistent symptoms due to chronic eyelash-globe contact. The surgical procedures performed were a modified Hotz procedure, Quickert sutures, and Jones-type retractor plication. Surgery was effective in at least 90% of all procedures.     

睑内翻改良手术的设计与效果观察

目的探讨一种治疗上睑瘢痕性睑内翻的改良手术方法的效果。方法设计上睑瘢痕性睑内翻的改良手术,包括:上睑重睑术皮肤切口、睑板楔形切除、皮肤部分切除及自穹隆部球结膜进针的褥式缝合线等。临床应用442例619眼,随访6个月,观察其矫正效果。结果本组442例(619眼)中,3例(3眼)3个月后仍有2~3根睫毛方向不正,接触眼球,经睫毛电解后痊愈。余439例(616眼)获得较为满意的治疗效果及美容效果。结论作者设计的上睑内翻改良手术,融合了传统的睑内翻矫正术及现代美容手术的优点,效果良好。     

Ophthalmodynamometry in the diagnostics of Grave's ophthalmopathy

BACKGROUND: Since endocrine orbitopathy is characterised by exophthalmos and increased orbital tissue pressure which may lead to a compression of and damage to the optic nerve, it was the purpose of this study to evaluate whether the increased orbital tissue pressure in endocrine orbitopathy is associated with an elevated central retinal vein pressure as estimated by ophthalmodynamometry, and whether the central retinal vein pressure changes in the course of the disease. PATIENTS AND METHODS: The prospective clinical study included 7 patients (13 eyes) with endocrine orbitopathy. They were screened for the prevalence of a spontaneous pulsation of the central retinal vein. In case of a missing spontaneous pulse, the collapse pressure of the central retinal vein was estimated by a modified ophthalmodynamometry using a corneal contact lens associated ophthalmodynamometric device. A group of 122 patients (156 eyes) without orbital or retinal diseases served as control group. RESULTS: The frequency of a spontaneous pulse of the central retinal vein was significantly lower in the study group (1/13 or 8%) than in the control group (121/156 or 78% p<0.001; odds ratio: 41.5). The central retinal vein collapse pressure as determined by ophthalmodynamometry was significantly higher in the study group (22.7+/-19.5 arbitrary units) than in the control group (4.7+/-12.8 arbitrary units) (p=0.002). For one patient with 7 examinations during a follow-up of 16 months, the central retinal vein pressure increased from 17 arbitrary units to 56 units, and decreased to 14 to 19 arbitrary units after initiation of a systemic therapy and regression of the exophthalmos. Three years later a spontaneous pulsation of the central retinal vein was detectable. CONCLUSION: Ophthalmodynamometry may be a useful examination for the indirect assessment of the orbital tissue pressure in patients with endocrine orbitopathy.     

Lower eyelid entropion repair with retractor mobilization and insertion onto the anterior surface of the tarsal plate

Purpose: To evaluate a modified surgical technique for the correction of lower eyelid involutional entropion in terms of recurrence rate and relief of symptoms.

Method: A prospective series of 67 consecutive eyelids in 55 patients who underwent lower eyelid entropion repair using a modified surgical approach not previously published in the literature to the authors’ knowledge. The surgical technique, via a skin crease incision, involves disinsertion of the lower eyelid retractors from the tarsus and conjunctiva and suturing the retractors onto the anterior surface of the tarsal plate. Standard excision of redundant lower lid skin and orbicularis muscle was also performed as well as lateral canthal tendon repair. All procedures were performed by a single surgeon (B. A. O’donnell). This study adhered to the principles of the Declaration of Helsinki.

Results: There were 67 eyelids with a minimum of 12 months follow-up: of these only 1 patient (1%) required revision surgery (average follow-up 24 months). Four other eyelids had persistent or recurrent irritation (6%) not suggestive of, or secondary to, recurrence. Seven eyelids (10%) had undergone previous operative repair with no further recurrence following their most recent surgery.

Conclusion: Disinsertion and reattachment of the retractors to the anterior tarsal plate in lower eyelid entropion repair is an effective surgical technique to improve lower eyelid stability. Although minimum follow-up is 12 months and average follow-up 24 months, longer follow-up would further evaluate this technique.