激光消融与电解治疗倒睫的对比研究

目的：探讨激光消融与电解治疗倒睫的疗效与安全性。

方法：选取倒睫患者50例76眼,分为激光消融和电解治疗两组进行倒睫治疗,观察记录两组患者术后眼部刺激症状、并发症及复发情况,共观察6mo。

结果：激光消融组一次治愈率81%,复发率19%,总治愈率94%; 电解治疗组一次治愈率49%,复发率63%,总治愈率72%。激光消融组一次治愈率和总治疗率显著高于电解治疗组,其复发率低于电解治疗组,两组差异有统计学意义(P<0.05)。激光消融组患者无特殊不适,治疗部位无瘢痕产生及皮肤色素脱失; 电解治疗组患者5眼出现轻度瘢痕。

结论：激光消融治疗倒睫成功率高,患者术中无不适症状,术后并发症少,是一种有效安全的临床治疗方法。     

倒睫的氩激光治疗

报告激光治疗倒睫44例,26例治疗效果满意无合并症。眼睑倒睫部位用2%利多卡因加1∶100 000肾上腺素局部麻醉,用棉签使睑缘外翻远离眼球,在裂隙灯下用氩激光烧灼倒睫及其毛囊,瞄准光的焦点对准睫毛毛囊,烧灼逐渐地深达眼睑实质,能量1.0W,光斑50μm,持续时间0.2秒,蓝-绿波(?)。最初激光烧灼常常是汽化睫毛和在睑缘产生小的褐色斑,每个毛囊烧灼20～30次,少数病例光斑为100μm,如睫毛的毛囊色素少,可防碍激光能量的吸收,此时可点一滴墨水到睫毛,使其容易吸收烧灼的能量,激光治疗后,睑缘涂用抗生素软膏,每日2～3次。     

Argon激光治疗复发性倒睫24眼

目的:评价氩激光治疗复发性倒睫的疗效和安全性。方法:Argon激光治疗18例(24眼)复发性倒睫,光斑50～200μm,时间0.25～0.5s,能量400～800mW。部分倒睫用美蓝染色后治疗。治疗全过程无需麻醉,平均随访时间6.12mo。结果:经过1～4次氩激光治疗,其中83.33%痊愈。刺激症状消失或明显减轻。激光治疗次数与倒睫数量间明显相关。治疗6wk后所有患者无睑缘畸形和新生血管形成。结论:氩激光治疗复发性倒睫较其他治疗方法安全、有效、简便、副作用小。     

倒睫激光疗效106例观察

目的 对氩激光光凝后的倒睫患者进行随诊,观察这种方法的临床效果.方法 应用氩激光治疗倒睫毛,将能量设为500～1000m W,时间为200m s,光斑50～200μm,使激光束对准倒睫毛的根部,产生2～3m m直径的小凹陷,继续激光破坏毛囊.激光后应用抗生素滴眼液一周.结果 73位患者106只眼接受了氩激光治疗.每根倒睫所需激光点数(53.7±19.1)点,68只眼经1次激光治愈,成功率64.2%,经3次激光,101只眼(95.3%)达到治愈效果.眼睑≤5个倒睫者,1次激光成功率78.9%;5～10个,33.3%;而超过10个倒睫的眼睑均需多次激光.沙眼1次激光成功率41.7%,睑缘炎72.4%,特发性倒睫81.8%.结论 氩激光光凝治疗倒睫是一安全、有效的方法.眼睑上的倒睫数越多,成功率越低.病因不同治疗效果也不同,其中沙眼的倒睫治疗效果差,需多次激光处理.     

XL-射频皮肤治疗仪消融祛除睑缘肿物

目的:研究XL-射频皮肤治疗仪(解放军总医院理疗科研制)消融技术祛除睑缘肿物的方法并观察其疗效。方法:采用射频消融治疗41例(42眼)睑缘肿物,其中睑缘痣10例,平视影响视野2例;睑缘疣14例,影响视野2例;睑缘乳头瘤12例;睑缘皮脂腺囊肿2例;脂溢性角化2例;血管瘤1例。采用分层、点状等治疗方法祛除。术后随访1～2mo,未祛除干净的残留物再次射频消融祛除,随访观察6～16mo。结果:39例(40眼)1次治愈,2例(2眼)1次治疗后残留少部分,2次治疗痊愈。术后愈合好,无复发,无色素沉着,未见瘢痕,无睫毛脱失,无睑缘变形。XL-射频皮肤治疗仪消融祛除睑缘肿物具有精准性高、不出血、不损伤睫毛、手术时间短、患者痛苦小、治疗后反应轻等特点。结论:XL-射频皮肤治疗仪消融祛除睑缘肿物是一项精准度易于控制、疗效显著的治疗技术,值得临床推荐的新疗法。     

倒睫Hotz矫正术切除睑板宽度的规范

Hotz术适用于矫正上睑多种倒睫.运用睑缘厚:睑板厚=2:1的规律,距睑缘3.5～4mm,1刀切软组织达睑板.沿睑缘侧皮肤切口垂直切睑板,切除睑板楔形条的睑板面宽规以1.8倍上睑缘宽,是这样切出的睑板槽沟夹角为68～78°,则倒睫回到倾斜110°最佳正常位置.临床实践与动物实验结果一致,4年复发率仅3%.Hotz术旧作法随手切除睑板宽度所矫正的倒睫4年复发率达64%,二者存在高度显著性差异.     

睑缘灰线切开带蒂轮匝肌瓣充填治疗上睑倒睫25例

倒睫是指睫毛转向后方的不正常状态,通常需要手术治疗,但是复发率较高。我们采用睑缘灰线切开带蒂轮匝肌瓣充填治疗上睑倒睫,临床效果较好,治疗病例无1例复发,报告如下。     

改进睑板切断术矫正瘢痕性睑内翻

疤痕性睑内翻是沙眼并发症之一。作者于88年9月—90年9月赴摩洛哥医疗队,在当地迂到不少沙眼所致的睑内翻病例,采用睑板部分切除松解术,取得了较好的效果,现解绍报告如下:临床资料本文共收集40例(40只眼),其中男性17例,女性23例,年龄18—70岁,平均53.5岁。右眼13只,左眼27只。所有病例均为上睑,有(?)期沙眼,睑结膜有明显疤痕,睑板显著增厚。倒睫部位颞侧2只眼,鼻侧5只眼,中央14只眼,整个睑缘均累及13只眼,有6只眼未记录。有1例曾作过其他手术方法而复发,有4只眼在缘已拔除部分倒毛。手术方法:①近睑缘皮下反穹窿部结膜下作浸润麻醉,用1号线作眼睑牵引缝线,角板翻转眼睑;②沿角板下沟作一与睑缘平行,从内眦部一直延伸到     

带蒂皮瓣睫毛转位术矫正复杂瘢痕性睑内翻的疗效

目的:探讨带蒂皮瓣睫毛转位术治疗复杂瘢痕性睑内翻的临床效果。方法:对严重瘢痕性睑内翻伴大量乱睫、双行睫,及以往行过一次或多次倒睫矫正术复发患者68例115眼行带蒂皮瓣睫毛转位术治疗,随访6～32(平均23.3)mo,观察术后睑缘形态及睫毛情况。结果:术后6mo内2眼、6mo后3眼有少许乱睫(<6根)发生,再次行电解治愈;余患眼上睑睑缘形态良好,睫毛背离眼球表面,无倒睫复发,无并发症发生;6mo治愈率91.7%(55/60,8例术后6mo后失访)。结论:带蒂皮瓣睫毛转位术对复杂瘢痕性睑内翻有较好疗效,复发率低。     

高能超脉冲CO2激光治疗睑缘肿物的疗效观察

目的 观察高能超脉冲CO2激光机对睑缘肿物的治疗效果。方法 采用高能超脉冲CO2激光机（Ultrapulse）对175例睑缘肿物（其中睑缘痣100例，睑缘疣42例，睑缘乳头状瘤33例）进行激光治疗，观察其疗效，随访时间6个月～5年。结果 所有病例均能一次治疗成功，且术后愈合好，无复发，未见色素沉着。激光治疗具有手术时间短、痛苦小、无出血，术后反应轻、无瘢痕、效果好等优点。结论 超脉冲CO2激光是治疗睑缘肿物的一种安全、有效的方法。     

Argon laser treatment for trichiasis.

The goal of trichiasis treatment is to eliminate misdirected cilia that irritate the eyeball. Established methods for removal of the eyelashes include epilation, electrolysis, and cryotherapy. Cryotherapy is currently the most effective method in widespread use, but has as potential posttreatment complications "visual loss, lid notching, corneal ulcer, acceleration of symblepharon formation, xerosis, cellulitis, activation of herpes zoster, skin depigmentation, and severe soft tissue reaction." (Wood JR, Anderson RL. Complications of cryosurgery. Arch Ophthalmol 1981;99:460-3.) The use of an argon laser allows more precise placement and control of the treatment, with better overall results. We reviewed the clinical course of 77 patients with a diagnosis of trichiasis, and 1 with distichiasis. We have found treatment of trichiasis with an argon laser with the patient under local anesthesia to be an effective office procedure.     

两种手术方法治疗小儿下睑倒睫的疗效比较

目的：通过对比缝线法和部分睫毛切除治疗小儿下睑倒睫的临床效果,筛选出一种有效治疗小儿下睑倒睫的方法。方法：将小儿下睑倒睫患者56例按照抽签方法随机均分为对照组与观察组,每组各为28例。对照组采用缝线法进行治疗,观察组采用部分睫毛切除法进行治疗。比较两组临床疗效、治疗前后患者满意度以及并发症发生率。结果：（1）对照组临床治疗总有效率为74%,观察组为89%,两组临床疗效差异具有统计学意义（P〈0.05）;（2）对照组治疗前后满意度评分分别为3.89±1.22与6.27±1.86分,观察组治疗前后满意度评分分别为4.00±1.34与8.95±2.34分,两组治疗前后满意度评分差异均具有统计学意义（P〈0.05）,且观察组治疗后满意度评分显著高于对照组（P〈0.05）;（3）两组均出现红肿及缝线脱落等并发症,对照组并发症发生率为21%,观察组为11%,两组并发症发生率差异具有统计学意义（P〈0.05）。结论：缝线法治疗小儿下睑倒睫简单易行,有时在患儿的配合下可在局部麻醉下进行,但复发率较高,部分复发患儿需再次手术; 部分睫毛切除可较彻底地解决小儿下睑倒睫问题,复发率低,但小儿需在全身麻醉下进行,风险大,并不适合在临床上广泛普及,可用于特殊的病例。     

Trichiasis

Trichiasis is a lid margin disorder in which the eyelashes are misdirected toward the ocular surface. It is a major cause of ocular morbidity. Trichiasis is secondary to inflammation and scarring of the eyelash follicles. There is a frequent association between trichiasis and cicatricial entropion and the correct diagnosis is mandatory for a successful treatment. There are several options for the management of trichiasis and the main purpose is to eliminate the anomalous cilia and improve the patient’s comfort. Temporary measures include eye lubricants, contact lenses, and mechanical epilation. Surgical treatments have initial success but long-term results are poor and recurrences are frequent. Definitive trichiasis treatments include bipolar electrolysis, radiofrequency ablation, cryotherapy and laser ablation, and surgical procedures. The techniques are described in detail along with possible complications and outcome.     

Lower Postoperative Scar Height is Associated with Increased Postoperative Trichiasis 1 Year after Bilamellar Tarsal Rotation Surgery

ABSTRACT

Purpose: To investigate the relationship between postoperative scar height and surgical success of the bilamellar tarsal rotation (BLTR) procedure, commonly used to correct trichiasis secondary to trachoma.

Methods: Using data from the Partnership for the Rapid Elimination of Trachoma surgical trial, comparing the new trachomatous trichiasis (TT) clamp with standard BLTR instrumentation, 145 sequential participants (245 eyelids) at their 1-year postoperative visit were examined. We measured internal and external scar heights from the upper eyelid margin for nasal, central and temporal sections and compared these to recurrence location at 1 year. We calculated odds of location-specific postoperative trichiasis and examined possible risk factors associated with postoperative trichiasis.

Results: A total of 77 eyelids (31%) had postoperative trichiasis, which most commonly occurred centrally. Regardless of instrumentation used, the closer the internal scar was to the eyelid margin, the higher the proportion that had recurrence, until 4.5?mm, at which point, the proportion leveled off. In bivariate analyses, the odds of central recurrence were significantly higher at all three locations when the internal scar height was <4.5?mm compared to higher scars. In multivariate analyses, central scar height <4.5?mm and severe baseline trichiasis were independently associated with central postoperative trichiasis.

Conclusion: Internal scar height <4.5?mm measured 1 year after surgery is more likely to be associated with postoperative trichiasis. Given these findings and the current World Health Organization recommendation for an incision height of 3.0?mm, further study into optimum incision height to minimize postoperative trichiasis is warranted.     

眼睑前层后徙术矫正严重及复发性上睑倒睫

目的探讨眼睑前层后徙术矫治严重及复发性上睑倒睫的临床疗效。方法对26例（49眼）严重的上睑倒睫和20例（30眼）复发性上睑倒睫行睑缘灰线切开,并将眼睑前层后徙,联合或不联合部分睫毛切除或眼睑皮肤松弛矫正术。结果上睑倒睫矫治较满意,复发率低。结论眼睑前层后徙术治疗严重及复发性上睑倒睫效果良好,简便易行。     

皮肤眼轮匝肌切除联合睫毛外翻褥式缝合矫正儿童下睑倒睫的疗效观察

目的 观察下睑皮肤眼轮匝肌切除联合睫毛外翻褥式缝合矫正术治疗儿童下睑倒睫的远期疗效。设计 回顾性病例系列。研究对象 2013年6月至2016年2月北京同仁医院眼科下睑倒睫患儿200例（400眼）,年龄3~10岁,平均5.56±2.30岁。方法 对200例（400眼）下睑倒睫者适量切除下睑皮肤及眼轮匝肌,睫毛外翻褥式缝合,皮肤连续缝合,部分患者联合灰线切开。术后随访观察6~12个月。主要指标 睫毛位置、畏光、流泪、角膜损伤、眼睑位置形态、有无下睑泪小点外翻、下睑皮肤凹陷性瘢痕、有无明显的下双眼皮。结果 术后患者倒睫全部矫正。200例患者术后随访观察6个月,倒睫无复发。170例患儿随访观察12个月,1例（1眼）倒睫部分复发。术后200例患儿畏光、流泪均消失,200例（380眼）角膜上皮损伤愈合,无下睑内、外翻,无下睑泪小点外翻,无下睑切口处皮肤凹陷性瘢痕,无明显下双眼皮,外观良好。结论 通过对下睑倒睫手术方案的精准设计,皮肤以及眼轮匝肌切除联合睫毛外翻褥式缝合,远期观察倒睫手术效果确切,且外观恢复良好。     

睑内翻倒睫669例的临床治疗体会

目的：回顾性分析不同类型的睑内翻倒睫的各种手术治疗方法,并评价它们的手术效果及其并发症。

方法：选自2011-06/2013-06共收治睑内翻倒睫患者669例1027眼。其中先天性睑内翻171例311眼,主要行睑板固定术、条形皮肤轮匝肌切除术、内眦赘皮矫正术及下睑轮匝肌增强术; 瘢痕性睑内翻260例407眼,主要行睑板固定术、部分睑板切除术及睑缘灰线劈开、下睑缩肌延长+异体巩膜植入术; 老年性或痉挛性睑内翻238例309眼,主要行下睑轮匝肌增强术。

结果：术后满意率97.2%,好转率0.7%,总有效率97.9%。其中先天性睑内翻倒睫的手术满意率97.1%,瘢痕性睑内翻倒睫的手术满意率96.6%,老年性或痉挛性睑内翻倒睫的手术满意率98.1%。手术后有22眼(2.1%)出现并发症,主要有倒睫复发、眼睑外翻、瘢痕形成、眼睑弧度不自然、双眼外观不对称等,经相应处理后患者均满意。

结论：对于不同种类型的睑内翻倒睫要采用不同的手术治疗方法。     

The association between epilation and corneal opacity among eyes with trachomatous trichiasis

AIM: To examine the association between epilation and corneal opacity (CO) among trichiasis patients presenting for surgery. METHODS: Cross sectional data from the STAR trial were utilised. Patients presenting for trichiasis surgery in Wolayta Zone, Ethiopia, were evaluated for current trichiasis status. Number of inturned lashes, evidence of epilation, level of entropion, trichiasis duration, and CO were collected. The primary outcome was prevalence of CO, stratified by entropion and epilation status. RESULTS: Approximately 10% of eyes with mild entropion had CO, regardless of epilation status. Among eyes with moderate entropion, epilated eyes were less likely to have CO than non-epilated eyes (21% v 34% p = 0.002). The same association was seen in eyes with severe entropion: 43% of epilated eyes while 74% of non-epilated eyes had CO (p<0.0001). Presence of CO increased with age. Adjusted models showed a protective effect of epilation in eyes with moderate or severe entropion (OR: 0.51; 95% CI: 0.32 to 0.83 and OR: 0.24; 95% CI: 0.13 to 0.45, respectively). Among eyes with mild entropion there was no difference in the prevalence of CO comparing eyes that were epilated with those that were not epilated. CONCLUSION: Entropion was the most significant predictor of CO. Cross sectional associations suggest that epilation may not be helpful for eyes with mild entropion, but may offer protection against CO in eyes with moderate to severe entropion. Epilation should not be a substitute for trichiasis surgery, however, as 43% of eyes with severe entropion that were epilated still had CO.