眼睑黄色瘤的手术治疗

在彻底切除黄色瘤的同时，增强眼睑形态美感。根据眼睑黄色瘤多发生在中老年人，均伴有不同程度的上睑皮肤松弛这一特点，在充分切除黄色瘤病变区的同时，行上睑松弛矫治术。手术采取超过黄色瘤边缘至少１ｍｍ作梭形切除，清除皮下组织及切口边缘之脂肪成分，通过保留病灶外侧邻近预定切除的相应面积皮肤，利用上睑皮肤移动度大的特点，直接间断缝合黄色瘤切除区缺损。其下方以缝合压线法，外侧皮肤切除区以切开法作成重睑皱襞。笔者自１９９３年以来对２１例（４０只眼）施行该手术。随访１９例，均获满意效果。手术彻底清除病灶的同时，行上睑松弛矫治术，合理设计，可获得理想的治疗、美容双重效果。     

Surgical indications for sunken eyelids

Although blepharoplasty is not the recommended procedure for patients with sunken upper eyelids, the authors have used the procedure successfully in several patients. Postoperatively, the appearance of these patients is similar to other patients undergoing blepharoplasty.     

Acute primary angle closure after periorbital facial procedures report of four cases and literature review

Aims: To report four cases of acute primary angle closure (PAC) after blepharoplasty and forehead lifting procedures and review the previous reported cases in the literature.

Methods: Four female subjects with age range of 50–67 years developed PAC 2–5 days after blepharoplasty and endoscopic forehead lifting procedures. All presented with pain, nausea, blurred vision, red eye, and eyelid swelling. Diagnosis was delayed in the first subject because of considering the signs and symptoms as usual postoperative ones. Presumed risk factors for the PAC were female gender (all), advanced age (all), pupillary dilation (all), and hyperopia (case 2). Results: Medical treatment controlled the pressure which was followed by bilateral YAG Laser iridotomy. They fully recovered with no optic neuropathy in their last follow-up examination 10 months to 10 years after the procedures.

Conclusion: Risk of PAC should be investigated preoperatively and its presentation should be considered in the postoperative follow-up of subjects with periorbital facial procedures.     

Ultrapulse 5000C 型超脉冲CO_2激光经结膜入路整复眼袋

为减少术中出血,提高眼袋整复效果,自１９９７年３月以来应用Ｕｌｔｒａｐｕｌｓｅ５０００Ｃ型超脉冲ＣＯ２激光经结膜行眼袋整复术２０４例,其中５２例局部伴有细密皱纹者采用电脑图形发生器（ＣＰＧ）手具进行激光除皱手术。术中出血极少,手术时间缩短,全部病例均获满意效果。对眶脂肪膨隆者用激光经结膜整复效果良好。     

上睑成形术治疗睑松弛症

目的　探讨睑松弛症与上睑皮肤松垂症的鉴别诊断与手术要点。方法　根据上睑解剖特点,利用改良的上睑成形术治疗睑松弛症。结果　手术治疗睑松弛症15例,随访2～5年,治愈率93%。结论　睑松弛症与上睑皮肤松垂症临床常易混淆,明确诊断后应用改良手术方法治疗,效果确切,复发率低。     

提上睑肌缩短术矫正临界重度先天性上睑下垂

目的评估提上睑肌缩短术矫正临界重度先天性上睑下垂的疗效。方法收集22例（27眼）临界重度先天性上睑下垂患者,患眼均接受提上睑肌缩短术,其中2例（2眼）眼球上转受限患者适当欠矫。术后3～6个月定期随访1次,评估上睑缘位置和角膜状况。结果随访4—46个月,矫正患者中16例（20眼）双眼上睑高度基本对称,3例（4眼）上睑下垂轻度复发,1例（1眼）完全复发。2例欠矫患眼上睑位置无明显变化。未见暴露性角膜炎、结膜脱垂或倒睫等并发症。结论提上睑肌缩短术可有效矫正临界重度先天性上睑下垂。     

超脉冲CO2激光辅助矫治下眼袋

目的评估高能超脉冲CO2激光经结膜内切口治疗眼袋的临床效果。方法1999年4月至今,局麻下用高能超脉冲CO2激光经结膜内切口治疗眼袋324例,切口不缝合,选用光斑大小为0.2mm手具,脉冲式,输出功率为12.5～18w。结果手术时间平均15min,术中、术后无出血,术后出现皮下於癍8例,无下睑外翻、下睑退缩、溢泪及感染等短期并发症,术后第5～7d有146例出现血泪水增多,持续1～2d后症状消失。随访3～6个月,324例中302例达到满意或比较满意的效果。22例不满意,其中8例两侧不对称,另14例双下睑皮肤仍有松弛皱纹存在。结论对于眶隔前不松弛、皮肤皱纹少的下睑眼袋,以高能超脉冲CO2激光,经结膜内切口进行治疗,是一种简便、安全、可靠的方法之一,但是必须严格掌握适应证。