经结膜下睑缩肌折叠联合外眦睑板条固定矫正退行性下睑外翻的疗效观

The clinical efficacy of trans-conjunctival lower eyelid retractor plication combined with lateral tarsal strip for involutional lower eyelid ectropion

目的探讨经结膜下睑缩肌折叠联合外眦睑板条固定术治疗退行性下睑外翻的效果。设计回顾性病例系列。研究对象北京同仁医院眼科退行性下睑外翻患者13例(13眼)。方法回顾患者的病历资料。所有患眼均采用经结膜入路,将下睑缩肌折叠缝合于睑板下缘;联合外眦睑板条固定。术后平均随访时间(7.1±2.5)个月。主要指标眼睑形态、睑缘位置、眼睑水平及垂直松弛度。结果最后随访时所有患者下睑外翻得到矫正,患者外观及症状明显改善。外翻程度从术前的Ⅱ~Ⅳ级降至术后为0~Ⅰ级(Z=-4.652,P<0.0001)。术前下睑垂直松弛度为(7.04±0.52)mm,最后随访时为(4.31±0.51)mm(t=22.45,P<0.0001)。术前水平松弛度为(9.5±0.91)mm,最后随访时为(5.19±0.52)mm(t=19.96,P<0.0001)。所有患者未发生过矫、复发、缝线脓肿、伤口异常或下穹窿变浅。结论本小样本量研究结果显示,经结膜折叠下睑缩肌联合外眦睑板条固定术是矫正退行性下睑外翻的简单有效方法。

Objective To observe the efficacy of trans-conjunctival lower eyelid retractor plication with lateral tarsal strip to correct involutional lower eyelid ectropion.Design Retrospective case series.Participants Thirteen patients(13 eyelids)with primary involutional lower eyelid ectropion in Beijing Tongren Eye Center.Methods All patients were performed plication of inferior retractor to the lower border of tarsus via a transconjunctival approach.Lateral tarsal strip was also performed simultaneously in all cases.The follow-up was(7.1±2.5)months.Main Outcome Measures Morphology and position of eyelid,vertical relaxation of eyelids,horizontal relaxation of eyelids.Results Until the last follow-up,all patients recovered well.According to the ectropion grading scale,the grade of ectropion was significantly reduced.The preoperative ectropion grade was Ⅱ~Ⅳ,and the postoperative grade was 0~Ⅰ(Z=-4.652,P<0.0001).The preoperative vertical relaxation of eyelids was(7.04±0.52)mm,and postoperative was(4.31±0.51)mm(t=22.45,P<0.0001).The preoperative horizontal relaxation of lower eyelid was(9.5±0.91)mm,and postoperative was(5.19±0.52)mm(t=19.96,P<0.0001).There were no cases of overcorrection,recurrent ectropion,suture abscess,wound dehiscence,or inferior fornix shortening after surgery.Conclusions This small sample size study shows that trans-conjunctival lower eyelid retractor plication combined with lateral tarsal strip for primary involutional lower eyelid ectropion is effective and simple.