Neuhaus R W, Hawes M J
Department of Ophthalmology, University of Texas Health Science Center, San Antonio.
Ophthalmology. 1992 Jan;99(1):153-7. doi: 10.1016/s0161-6420(92)32022-6.
A retrospective review of preoperative findings and postoperative results of conjunctival cul-de-sac fixation surgery performed on 12 patients with acquired anophthalmos and an inadequate inferior conjunctival cul-de-sac was performed. Patients with inadequate conjunctiva or other subconjunctival cicatricial shortening of the inferior cul-de-sac were not suitable candidates for conjunctival cul-de-sac fixation surgery and therefore were excluded from this retrospective study. Only those patients with adequate conjunctiva and loss of inferior cul-de-sac fixation to the lower eyelid retractor complex were selected. Clinical evaluation and theoretical anatomical analysis of this group preoperatively suggested that the absent inferior conjunctival cul-de-sac fixation could allow the intraconal orbital fat to migrate anteriorly, compromising the inferior fornix and prolapsing the conjunctiva of the cul-de-sac superiorly. Surgical correction required direct fixation of the conjunctival cul-de-sac to the periosteum immediately posterior to the inferior orbital rim. No externalized sutures or stents were needed to recreate the inferior conjunctival cul-de-sac. All 12 patients had improved ability to retain a prosthetic eye postoperatively. However, two patients had minimal postoperative lower eyelid retraction and an additional two patients had minimal lower eyelid entropion after surgery. Secondary surgery was not required in any patient.
对12例获得性眼球缺失且下结膜囊不足的患者进行结膜囊固定手术的术前检查结果和术后效果进行了回顾性研究。结膜不足或下结膜囊其他结膜下瘢痕性缩短的患者不适合结膜囊固定手术，因此被排除在这项回顾性研究之外。仅选择那些结膜充足且下结膜囊与下睑缩肌复合体固定缺失的患者。术前对该组患者的临床评估和理论解剖分析表明，下结膜囊固定缺失可能会使眶内脂肪向前迁移，损害下穹窿并使结膜囊结膜向上脱垂。手术矫正需要将结膜囊直接固定于眶下缘后方的骨膜上。重建下结膜囊无需外置缝线或支架。所有12例患者术后佩戴义眼的能力均有所改善。然而，2例患者术后下睑退缩轻微，另外2例患者术后下睑轻度睑内翻。所有患者均无需二次手术。
