麻风麻痹性下睑外翻矫治的远期疗效

Long-term results after the correction of the paralytic ectropion caused with leprosy in 115 eyes

目的分析麻风所致麻痹性下睑外翻手术矫治的远期疗效。方法对术后已随访2～4年的74例(115只眼)麻风麻痹性下睑外翻手术病例进行了手术前后的分析。手术方法包括内眦成形、内眦韧带悬吊、内眦切除、外侧睑板悬吊、外眦成形和睑缩短术等。结果结膜充血从93只眼减少到40只眼(减少57%);溢泪从107只眼(轻度24只眼、中度36只眼、重度47只眼)减少到90只眼(轻度40只眼、中度32只眼、重度18只眼);睑闭合不全(轻闭时)从平均68mm下降到53mm(减少221%);角膜病变从51只眼减少到36只眼(减少294%)。手术前后平均视力无改变。总体手术疗效优18只眼(157%),良45只眼(391%),一般41只眼(357%),差11只眼(96%)。结论麻风麻痹性下睑外翻手术矫治对患者的角膜有一定的保护作用,并可改善结膜充血和溢泪等症状。

Objective\ To analyze the long term results after the correction of the paralytic ectropion in leprosy. Methods\ Seventy four patients with 115 paralytic ectropion eyes after leprosy were treated with the surgical procedures included medial canthoplasty, medial canthal tendon plication, lateral tarsal strip, medial canthal resection, lateral canthoplasty, and lid shortening. The results were evaluated with the follow ups from 2 to 4 years. Results\ The eye redness was reduced from 93 to 40 while the epiphora from 107 eyes (24 mild, 36 moderate and 47 severe) to 90 (40 mild, 32 moderate and 18 severe). The mean lid gap in mild eye closure was reduced from 6.8 mm to 5.3 mm and the cornea lesion was reduced from 53 to 36. The results were excellent in 18 eyes (15 7%), good in 45 eyes (39 1%), fair in 41 eyes (35 7%) and poor in 11 eyes (9 6%). However, the mean visual acuity remained same pre and postoperatively. Conclusions\ Surgical correction of ectropion is helpful for cornea protection and could improve the signs and symptoms of the eyes such as epiphora and redness.\;