两种不同术式治疗儿童先天性下睑内翻倒睫对眼表微环境和视功能的影响

Effects of two different surgical treatments for congenital lower eyelid inverted trichiasis on the ocular surface microenvironment and visual function in children

目的观察缝线法和眼轮匝肌切除术矫正儿童先天性下睑内翻倒睫的临床疗效,重点分析手术对儿童眼表微环境和视功能的影响。方法前瞻性病例对照研究。研究对象为西京医院2013年9月至2018年3月期间就诊的3~15岁的儿童先天性下睑内翻倒睫患者,分为两组,缝线法组为使用缝线法手术矫正的62例(103只眼),切除术组为使用眼轮匝肌切除术矫正的共57例(95只眼)。术前与术后1周时观察泪膜破裂时间(BUT)、最佳矫正视力(BCVA)变化;于术后半年、1年、2年时统计治疗的有效率、复发率等。结果两种术式随访1年治疗有效率缝线法组为80.58%、眼轮匝肌切除组为92.63%(P<0.05);2年时复发率分别为25.24%和7.37%(P<0.05)。BUT:缝线法组术前为(5.63±1.61)s,术后1周为(13.51±2.32)s;切除术组术前为(5.47±2.14)s,术后1周为(12.34±2.12)s;两组术后与术前自身相比均明显改善(P<0.05),但两组之间比较差异无统计学意义(P>0.05)。BCVA:缝线法组术前为0.71±0.19,术后1周为0.82±0.11;切除术组术前为0.67±0.25,术后1周为0.78±0.17;两组术后视力均较术前明显提高(P<0.05),但两组之间比较差异无统计学意义(P>0.05)。结论缝线法和眼轮匝肌切除术在早期均可有效提高眼表泪膜稳态,并恢复受损的视功能。眼轮匝肌切除术远期有效率高于缝线法,但缝线法操作简单,临床上应综合考虑病情、术者经验和患者对手术治疗的理解而选择恰当的术式。

Objective To observe the clinical efficacy of suturing method and orbicularis oculi muscle resection in the correction of congenital lower eyelid inverted trichiasis in children,mainly on the impact of surgery on the ocular surface microenvironment and visual function of children.Methods Prospective case control study.This study included children with congenital lower eyelid inversion and trichiasis aged 3 to 15 years who were treated at the Xijing Hospital from September 2013 to March 2018.They were divided into two groups:the suture group included 62 patients(103 eyes),and the orbicularis oculi muscle resection group included 57 patients(95 eyes).The breakup time of tear film(BUT)and visual acuity changes were observed before and at 1 week after operation.The effective rate and recurrence rate were assessed at half year,one year and two years,postoperatively.Results At the 2-year follow up,the effective rate and recurrence rate were 74.76%and 25.24%in suture group,and 92.63%and 7.37%in resection group,respectively(P<0.05).The BUT was(5.63±1.61)s preoperatively and(13.51±2.32)s at 1 week postoperatively in the suture group,and was(5.47±2.14)s preoperatively and(12.34±2.12)s at 1 week postoperatively in the resection group.The postsurgical BUT in both groups were significantly better than those before the surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).The visual acuity of the suture group was 0.71±0.19 before and 0.82±0.11 at 1 week after the surgery.In the resection group,it was 0.67±0.25 before and 0.78±0.17 at 1 week after the surgery.The postoperative visual acuity in both groups were better than those before the surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusions Both suture and orbicularis oculi muscle resection can effectively improve the homeostasis of the tear film on the ocular surface and restore impaired visual function.The long-term effectiveness of orbicularis oculi muscle resection is better than the suturing method.However,the suturing method is simpler to operate.Therefore,in clinical practice,it is necessary to choose the appropriate surgical method after comprehensive assessment of the patient condition,the doctor experience and the patient's understanding of the surgical treatment.