探讨Medpor下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻

Medpor lower eyelid spacer graft combined with lateral tarsal strip procedure for severe lower eyelid paralytic ectropion

目的探讨Medpor下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻的临床疗效。方法回顾性系列病例研究。收集16例(16眼)重度麻痹性下睑外翻患者的临床资料,所有患者均采用Medpor下睑插片联合外眦睑板条悬吊术治疗。记录并比较16例患者术前及术后1周、3个月、12个月的眼睑闭合不全量、下睑退缩量、角膜上皮分级、下睑水平及垂直松弛度等级。结果 16例患者术后下睑外翻均矫正,随访期内均未见复发。术后1周、3个月、12个月,下睑退缩量、眼睑闭合不全量均较术前明显下降,差异均有统计学意义(均为P<0.05);术后各时间点间比较,差异均无统计学意义(均为P>0.05)。随访期间各患者的角膜上皮分级、水平及垂直松弛度等级均较术前明显改善,随访期末均为0级或1级。无1例患者术后出现眶内出血、感染及内植入物暴露、排斥、移位等严重并发症。结论采用Medpor下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻,可在保留患者视功能的前提下矫正下睑外翻及眼睑闭合不全,有效改善患者眼表状况及外观,且术后效果较为稳定。

Objective To discuss the clinical effects of porous high density polyethylene （Medpor） lower eyelid spacer graft combined with lateral tarsal strip procedure for severe lower eyelid paralytic ectropion. Methods A retrospective case series study was carried out at the Second Hospital of Dalian Medical University. And there were 16 cases （16 eyes） with severe lower eyelid paralytic ectropion,in all who were cured with Medpor lower eyelid spacer graft combined with lateral tarsal strip suspension surgery. The curative effect was assessed upon measurement of hypophasis, the a- mount of eyelid retraction, corneal epithelial change degree, vertical laxity degree and horizontal laxity degree of the lower eyelid. The patients were reassessed at the 1st week,3rd month,and 12th month during the follow-up. Results Postoperatively,none of the 16 cases with severe lower eyelid paralytic ectropion presented recurrence of ectropion. The amount of hypophasis and eyelid retraction at the 1 th week, 3rd month, and 12th month after operations significantly decreased, and there were statistical differences compared with pre-operation （ all P 〈 0.05 ） ; In the follow-up period, they had no obvious change （P 〉 0.05 ）. Post-operatively, corneal epithelial change degree, vertical and horizontal laxity degree of lower eyelid had obvious improvement, and they all reached first stage degree in the end of the follow-up visit. There was no severe complication. Conclusion The high density porous （Medpor） lower eyelid spacer graft combined with lateral tarsal strip procedure for severe lower eyelid paralytic ectropion can reduce the lower eyelid laxity, improve the condition of ocular surface and outlook, and are beneficial to keep the patients＇ visual function in the long-term.