儿童先天性下睑内翻合并倒睫的手术时机对眼内屈光发育的影响

Effect of surgical time on the development of visual refraction in children with congenital entropion and trichiasis

目的:研究儿童先天性下睑内翻合并倒睫的手术对于眼内屈光发育的影响,进一步探讨患儿的最佳手术时机。方法:前瞻性队列研究。纳入2016-09/2018-06在我院确诊为先天性下睑内翻合并倒睫并接受下睑内翻矫正手术的患儿30例59眼。将其分为低龄组(2~3岁)10例20眼,中龄组(4~6岁)10例20眼和大龄组(7~12岁)10例19眼。所有患儿在全身麻醉下接受下睑皮肤眼轮匝肌切除术,合并内眦赘皮患儿同时接受内眦切开联合L型缝合术式,轻度下睑内翻不伴眼轮匝肌肥厚的患儿接受缝线术,术后3mo合并弱视及屈光不正者接受屈光矫正,随访6~12mo。测定三组患儿术前及术后6mo眼内屈光状态,视力发育情况及角膜地形图结果。结果:所有患儿术后下睑内翻矫正效果良好,无欠矫,外翻或眼睑角状畸形者。手术前后角膜散光(CC)三组患儿均有差异(P<0.05),视网膜检影总散光值(RC)、BCVA,低龄组和中龄组患儿有差异(P<0.05),大龄组无差异(P>0.05)。结论:先天性下睑内翻合并倒睫患儿在6岁以内接受手术矫正可以改善眼球散光值。4~6岁患儿术前顺规散光发病率高,应尽早接受手术治疗及屈光矫正。

AIM:To investigate the effect of surgical time on the development of visual refraction in children with congenital entropion and trichiasis.METHODS:This was a prospective interventional study.Fifty nine eyes of 30 patients aged from 2 to 12 years old who suffered congenital lower eyelid entropion with trichiasis were divided into three groups according to the age.Improvement in binocular vision,refractive error,retinography astigmatism and cornea astigmatism by topography were analyzed.All patients were followed up for a period of 6 to 12mo.RESULTS:There were no significant complications of overcorrection,undercorrection or eyelid deformity.The postoperative corneal astigmatism(CC)was significantly improved in three groups(P<0.05).retinography astigmatism(RC)and best corrected visual acuity(BCVA)were significantly improved in low-aged and middle-aged groups(P<0.05).The proportion of astigmatism with the rule and amblyopia was larger in middle-aged group.The postoperative CC,RC and BCVA was not statistically different in high-aged group(P>0.05).CONCLUSIONS:Children with congenital entropion and trichiasis should be corrected surgically before 6 years old.The incidence of astigmatism with the rule and amblyopia is higher in 4 to 6 aged children and should be corrected earlier.