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。     

肉毒杆菌毒素在眼科的应用(四)

五、Ａ型肉毒杆菌毒素在其它肌肉痉挛性疾病中的应用（一）下睑内翻痉挛性下睑内翻是由于下睑缩肌和眦角肌腱的老年性松弛，睑板前和眶膈前的眼轮匝肌在收缩时向上运动引起的。在下睑轮匝肌注射Ａ型肉毒杆菌毒素可以矫正痉挛性下睑内翻。注射剂量为１２５Ｕ／０５ｍｌ...     

共同性斜视眼外肌的组织学及肌酶组织化学观察

目的　为探讨斜视的发病机理及手术时机。方法　对３１ 例斜视病变眼外肌的组织学、骨骼肌肌酶组织化学和非肌酶组织化学技术进行研究。结果　斜视眼外肌肌组织萎缩, 排列较紊乱, 内核肌纤维增多, 部分肌组织见坏死及吞噬现象, ＡＴＰ 酶染色见１ 型肌纤维占优势, 肌外膜结缔组织明显增生, 部分病变眼外肌仅见成熟的胶原组织。结论　共同性斜视眼外肌的确产生了病变, 病理改变主要为肌源性损害。同时在研究中发现部分斜视眼外肌血管周围可见单核细胞和中性白细胞浸润, 不能排除感染的可能性。     

浸润性突眼眼外肌超微结构的研究

目的 研究浸润性突眼眼外肌组织病理学及超微结构的改变,为阐明其发病机制奠定基础。方法 将１０例严重浸润性突眼术后肥大的眼外肌组织标本,每例标本１／２行ＨＥ染色,光镜观察;１／２标本制作超薄切片,行透射电镜观察。结果 光镜检查显示,早期浸润性突眼眼外肌细胞无异常,中晚期眼外肌细胞肌浆凝缩,颗粒变性,部分溶解形成空泡,部分肌纤维变性坏死,电镜检查显示,早期可见肌原纤维部分Ｚ线紊乱、消失。中晚期时可见不     

改良的下睑内翻矫正术15例

目的探讨老年性痉挛性下睑内翻的手术方法和效果。方法对15例(15眼)下睑内翻施行了经皮肤的部分眼轮匝肌切除、下睑缩肌前移和下睑缩短联合下睑多余的松弛皮肤切除。结果经6月～3a的随访观察,全部患者内翻矫正,自觉症状消失,无1例复发。结论经皮肤的下睑内翻矫正术能有效消除这种内翻的各种成因,手术操作简单,疗效可靠。     

眼型Graves病眼外肌的组织病理学研究

对７例眼型Ｇｒａｖｅｓ病的眼外肌和５例正常人的眼外肌进行了光镜、电镜的对比性观察。发现病变组下直肌和提上睑肌以胶元纤维增生为主，内直肌和眼睑轮匝肌则以粘多糖浸润为主，肌纤维变性、萎缩、肥大及纤维化共存。电镜观察发现病变肌纤维中线粒体大量增生、密集，其嵴疏松，基质颗粒消失。肌浆网扩张，糖元增加，可见脂滴。间质胶元纤维增生，毛细血管增加、扩张、充血。并将病理改变与临床特征之间的关系作了简要讨论。     

下睑缩肌移位联合外眦韧带缩短术矫正退行性下睑内翻

目的：观察和对比下睑缩肌移位联合外眦韧带缩短术及单纯眼轮匝肌切除术治疗老年退行性睑内翻的方法及疗效。
　　方法：收集我院因退行性睑内翻住院的患者,观察组共40例70眼,双眼发病30例,采用下睑缩肌移位联合外眦韧带缩短术治疗退行性下睑内翻;对照组共20例26眼,其中双眼发病6例,采用眼轮匝肌切除术治疗退行性下睑内翻,观察两组患者术后1 wk的矫正率、双眼睑对称性、过矫率;并随访6mo,观察远期复发率、双眼睑对称性、过矫率。
　　结果：术后1 wk拆线时观察,观察组矫正率98.6%,欠矫率1.4%,眼睑对称性100%,仅有1眼轻度过矫;对照组矫正率92.3%;眼睑对称性100%,欠矫率7.7%。术后6mo观察组矫正率95.2%;欠矫率3.2%,过矫率1.6%。对照组矫正率87%,2眼复发,1眼欠佳。双眼睑对称性、过矫率方面差异无明显统计学意义(P>0.05),在矫正率方面两者有明显差异(P<0.05)。
　　结论：下睑缩肌移位联合外眦韧带缩短术与眼轮匝肌切除术治疗退行性下睑内翻相比,下睑缩肌移位联合外眦韧带缩短术长期疗效术后复发率明显降低。     

下睑眼轮匝肌及其筋膜部分切断加悬吊矫正老年性下睑内翻

目的探讨下睑眼轮匝肌及其筋膜部分切断加悬吊矫正老年性下睑内翻的效果。方法利用眶肌筋膜韧带松解及提紧矫正老年性下睑内翻,将下睑眼轮匝肌近外眦部分斜行切断,并悬吊固定在眶外缘骨膜或外眦韧带上,使下睑紧张度提高。结果本组共21例（42跟）均施行下睑跟轮匝肌及其筋膜部分切断加悬吊加强下睑张力,矫正下睑内翻,随访6个月以上,手术均取得良好效果,无并发症发生。结论下睑眼轮匝肌及其筋膜部分切断加悬吊矫正老年性下睑内翻,可提紧下睑,矫正睑内翻,并获得了较好的眶区年轻化效果。     

正常人眼外肌组织学初步研究

目的 探讨正常人眼外肌组织细胞学结构并通过组织化学染色法对眼外肌纤维分类.方法 10条正常人眼外肌分为肌腹部、赤道部和近肌腱部,行肌球蛋白三磷酸腺苷酶(mATPase)和还原型辅酶Ⅰ四唑氮还原酶(NADH-TR)染色,测量肌纤维及构成比.另15条正常人眼外肌,行常规组织病理学染色和Masson染色.结果 正常人眼外肌在肌腹部可分为眶层和球层;赤道部无明显分层,肌肉周边部有斜行或横行肌纤维伴较多结缔组织穿插,肌肉外周包绕增厚胶原结缔组织环.近肌腱部为球层肌纤维.组织化学染色可将眼外肌纤维分为5类,肌腹部、赤道部和近肌腱部各类肌纤维比例不同.结论 人眼外肌结构独特,分为不同肌纤维特点的眶层和球层,球层通过肌腱附着于巩膜,眶层终止于眼球赤道部的Pulley结构.组织化学染色法可将眼外肌纤维分类,不同位置的肌纤维构成不同.     

老年性下睑内翻矫正术不同术式的疗效比较

目的:比较老年性下睑内翻矫正术不同术式的疗效,为临床工作提供更多建议和方法。方法:对185例286眼老年性下睑内翻的患者分别采用缝线+缘间切开术、眼睑皮肤切除术、单纯眼轮匝肌切除术和眼轮匝肌折叠缩短术进行矫正,观察长期(平均2a)复发率。结果:眼轮匝肌折叠缩短术长期效果最优,皮肤切除术最差。结论:眼轮匝肌折叠缩短术对老年性下睑内翻具有很好的矫治作用。     

Effect of hyperthyroidism on the orbicularis oculi muscle in rabbits

PURPOSE: To determine the effect of hyperthyroidism on both myofiber number and myosin heavy-chain isoform composition within the palpebral orbicularis oculi muscle in rabbits. METHODS: Four New Zealand White rabbits were made hyperthyroid by injection of 3,3,3'-triiodothyroinine intraperitoneally every other day for 1 month. Four rabbits were used as control animals. After 1 month the rabbits were euthanized, and the eyelids were excised and sectioned in a cryostat. The sections were immunostained to determine the presence of fast, slow, and neonatal myosin heavy-chain isoforms. To determine alterations in myofiber number, differential counts of myofiber number and the cross-sectional areas of the muscle fibers were performed with the use of computerized morphometry. RESULTS: The orbicularis oculi muscle in the palpebral portion of the eyelids from hyperthyroid rabbits had significantly fewer myofibers compared with control eyelids, predominantly as the result of a loss of myofibers in the preseptal region. The remaining fibers showed continued expression of fast myosin but upregulated coexpression of slow myosin isoform. CONCLUSIONS: Hyperthyroidism led to reduced orbicularis oculi muscle in the rabbit model and an alteration in the myosin heavy-chain isoform composition. This finding may help explain the clinical finding of eyelid retraction in patients with Graves orbitopathy.     

三种不同术式治疗老年性睑内翻的疗效比较

目的:观察比较皮肤眼轮匝肌切除法,眼轮匝肌缩短法(wheeler法),改良式老年性睑内翻矫正术3种不同术式治疗老年性睑内翻的疗效。方法:回顾本医院眼科2000-01/2007-12间治疗的老年性睑内翻患者资料,分析比较皮肤眼轮匝肌切除法,眼轮匝肌缩短法,改良式老年性睑内翻矫正术3种不同术式的疗效,复发率及并发症。结果:皮肤眼轮匝肌切除组,眼轮匝肌缩短组和改良式老年性睑内翻矫正术组治愈率分别为86.2%,94.1%,97.1%,复发率分别为17.2%,8.8%,1.4%。眼轮匝肌缩短组有6例术后发生睑裂不对称或泪小点移位并发症。结论:单纯皮肤眼轮匝肌切除法治疗老年性睑内翻复发率高,而眼轮匝肌缩短法容易产生外观不对称并发症。改良式老年性睑内翻矫正术安全可行,不易复发,对复发性睑内翻亦有效,值得推广。     

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。     

眼轮匝肌切除联合眼轮匝肌缩短下睑缩肌复位术治疗老年性下睑内翻

目的：探究眼轮匝肌切除联合眼轮匝肌缩短下睑缩肌复位术治疗老年性下睑内翻患者疗效。

方法：回顾性分析。选取2019-06/2021-06我院收治老年性下睑内翻患者97例175眼,依据治疗方式分两组：对照组47例82眼接受眼轮匝肌切除术进行治疗,联合组50例93眼接受眼轮匝肌切除联合眼轮匝肌缩短下睑缩肌复位术进行治疗。比较两组患者近期疗效、围手术相关指标、手术前后症状与体征评分、手术前后睑裂宽度、睫毛朝向、泪阜显露率、并发症、患者满意度。

结果：术后3mo联合组患者总有效率显著高于对照组(95% vs 80%,P=0.004); 联合组患者手术出血量、手术时间以及住院时间均明显高于对照组(P<0.001); 联合组术后流泪、异物感、畏光以及刺激感症状体征评分均低于对照组(均P<0.001); 联合组患者手术后睑裂宽度、睫毛朝向、泪阜显露率均高于对照组(均P<0.001); 联合组患者术后并发症发生率低于对照组(8% vs 18%,P=0.032); 联合组患者术后舒适度、倒睫矫正、瘢痕外观、双眼对称以及外形美观患者满意度评分均高于对照组(均P<0.001)。

结论：应用眼轮匝肌切除联合眼轮匝肌缩短下睑缩肌复位术治疗老年性下睑内翻患者安全有效,可以满足患者美容要求。     

Orbicularis oculi muscle extirpation in a combined procedure for involutional entropion

Many factors are important in the pathophysiology of involutional entropion, including defects of the lower eyelid retractors, canthal tendon laxity, and acquired enophthalmos. The role of the overriding preseptal orbicularis oculi muscle is often ignored in modern techniques of entropion repair. The author describes a technique of extirpation of the preseptal orbicularis oculi muscle combined with repair of the lower eyelid retractors and a lateral tarsal strip procedure for the repair of primary and recurrent involutional entropion. Lateral canthal tendon laxity is recognized in most patients in this age group and must be corrected to avoid postoperative overcorrection and ectropion. Removal of the preseptal muscle had no clinical effect on the lacrimal pump and did not cause any significant cicatricial eyelid abnormalities. This combined procedure has been used in 50 eyelids of 40 patients with excellent functional and cosmetic results. Orbicularis extirpation is not advocated in combination with a marginal rotation procedure.     

Pathogenesis of Involutional Ectropion and Entropion: The Involvement of Matrix Metalloproteinases in Elastic Fiber Degradation

Purpose:?To determine the elastic fiber content and ultrastructure as well as the expression of elastin-degrading enzymes in biopsy specimens from patients with involutional ectropion and entropion.

Materials and Methods:?Twenty consecutive patients with involutional ectropion (group 1) and twenty consecutive patients with entropion (group 2) were matched with twenty control patients (basal cell carcinoma) regarding age and gender. Full-thickness eyelid resections performed in study and control patients were examined by light and transmission electron microscopy, computer-assisted measurements, and immunohistochemistry using antibodies against matrix metalloproteinase (MMP)-2, MMP- 7, and MMP-9. The Kruskal-Wallis test and the Pearson chi-square test were performed.

Results:?Histopathologic analysis of the surgical specimens from patients with involutional ectropion and entropion showed a significant loss of elastic fibers in the eyelid skin, the pretarsal orbicularis oculi muscle, the perimeibomian tarsal stroma, and the intermeibomian tarsal stroma (P < 0.001). Residual elastic fibers revealed an abnormal ultrastructure. Immunohistochemistry demonstrated a significant overexpression of MMP- 2, MMP-7, and MMP-9 in the eyelid skin, the pretarsal orbicularis oculi muscle, the perimeibomian tarsal stroma, the intermeibomian tarsal stroma, and the conjunctiva in groups 1 and 2 compared to controls (P < 0.001).

Conclusions:?The present findings indicate that upregulation of elastolytic enzymes contributes to elastic fibre degradation in patients with involutional ectropion and entropion.     

The effects of tetanus toxin on the orbicularis oculi muscle

PURPOSE: Tetanus toxin can cause localized neuromuscular weakness, but it also can produce systemic tetany. The action of tetanus toxin on the orbicularis muscle has not been studied in animals immunized to prevent systemic tetany. Our objective was to determine whether tetanus toxin could be used to treat orbicularis oculi muscle spasms. METHODS: We analyzed the clinical, electrophysiologic, and histopathologic effects of tetanus toxin injected into the orbicularis oculi muscle of rabbits with passive immunity to tetanus toxin. In six rabbits, the orbicularis oculi function in both eyes was assessed clinically, and the baseline orbicularis oculi muscle action potential was measured physiologically with electromyography (EMG). The rabbits then were immunized against tetanus toxin with tetanus immunoglobulin for immediate and definitive immunity. Tetanus toxin was injected into the left orbicularis oculi muscles, leaving the right eyes as controls. Ten days later, the rabbits were again assessed by clinical examination and with EMGs on both the injected side and the noninjected side. The animals were killed at 14 days, and the orbicularis muscle was removed from both sides. The injected and control tissues were examined microscopically for signs of neuromuscular denervation. RESULTS: All six rabbits showed weakness in eye closure on the side injected with tetanus toxin. In addition, four rabbits developed complete ear ptosis on the tetanus toxin injected side because of spread of the toxin to adjacent ear muscles. EMGs showed both a denervation of the orbicularis oculi muscle and a poor blink potential on the side injected with tetanus toxin. Histopathologic studies of the orbicularis oculi muscle injected with tetanus toxin showed angulation of both slow and fast types of muscle fibers compatible with neuromuscular denervation. CONCLUSIONS: Tetanus toxin can cause localized orbicularis oculi weakness, as documented clinically, physiologically, and microscopically, without producing systemic tetany in immunized rabbits. Tetanus toxin may have a potential application in the treatment of blepharospasm and hemifacial spasm.     

外眦成形及下睑外翻缝线联合术治疗退行性下睑内翻的效果

 目的 探讨联合外眦成形、下睑外翻缝线以及睑板前轮匝肌切除术治疗退行性下睑内翻的疗效。设计 回顾性病例系列。研究对象 北京同仁眼科中心19例（23眼）退行性下睑内翻患者。方法 手术包括外眦成形矫正水平眼睑松弛,睑板前轮匝肌切除解除眼轮匝肌骑跨,下穹窿皮肤缝线折短下睑缩肌。观察术前术后患者眼睑形态、位置,有无溢泪等。随访8~12个月。主要指标 眼睑形态、位置,有无溢泪。结果 到最后随访时,所有患者下睑对称无畸形;1例患者（1眼）在睁眼时下眼睑与眼表贴附不紧密,但无明显内外翻及溢泪发生。随访期间无复发或过矫现象发生。结论 针对多种致病因素的联合外眦成形、睑板前轮匝肌切除以及下穹窿皮肤缝线术治疗退行性下睑内翻简单有效。     

A new approach to the correction of involutional entropion by pretarsal orbicularis oculi muscle fixation

A new surgical technique to repair involutional entropion involves fixation of a strip of dissected and displaced pretarsal orbicularis oculi muscle. In 112 patients followed up for an average of 14 months, this technique was successful. The procedure is easy to perform and complications were minimal.     

Anatomical factors influencing development of trichiasis and entropion in trachoma.

There has been no published investigation into the reasons why some patients with severe trachomatous conjunctival scarring develop entropion and trichiasis while others do not. In a population of leprosy patients with severe trachomatous conjunctival scarring the authors found that lagophthalmos correlated with the absence of trichiasis and entropion. We suggest that orbicularis oculi muscle function, as well as other anatomical variations among individuals, may contribute to the development of trachomatous entropion and trichiasis in patients with conjunctival scarring.