National Institute for Health Research, Biomedical Research Centre for Ophthalmology, 2nd Floor Richard Desmond Childrens Eye Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, NHS Foundation Trust, London, United Kingdom.
Ophthalmology. 2010 Apr;117(4):839-46. doi: 10.1016/j.ophtha.2009.09.009. Epub 2010 Jan 25.
To identify and describe the different procedures used in the treatment of floppy eyelid syndrome (FES) at Moorfields Eye Hospital and to evaluate their effectiveness.
Cross-sectional study.
A total of 71 patients who had undergone surgery for FES over a 13-year period since 1995 at Moorfields Eye Hospital were recruited. Retrospective data from 7 patients were also included, providing data for 78 patients.
Patients underwent a full ocular examination. A survival analysis was determined by plotting Kaplan-Meier curves for each type of procedure encountered. Comparison of survival trends was made using a log-rank test. The possible effects of bias arising from bilaterality of the condition were investigated using a sensitivity analysis and a Cox regression analysis allowing for clusters. Tests for surgeon bias were made using the Fisher exact test.
Recurrence of the condition. An assessment of recurrence was made clinically by 2 independent observers who were masked to the type of surgery the patient had undergone.
Four different forms of surgical treatment were encountered: (1) Full-thickness wedge excision (FTWE) (26 patients, 33 procedures); (2) Upper lid lateral tarsal strip (LTS) (31 patients, 43 procedures); (3) Medial canthal (MC) and lateral canthal (LC) plication (15 patients, 19 procedures); (4) Medial tarsal strip (6 patients, 6 procedures). A total of 44 of 101 procedures had failed. Superior long-term survival outcomes of both LC/MC plication (P = 0.003) and upper lid LTS (P = 0.001) procedures over FTWE was demonstrated. However, survival comparison between the LC/MC plication and LTS groups did not achieve significance (P = 0.37). No significant difference in outcome between surgeon groups of equivalent experience was demonstrated (P = 0.18). No bias arising from bilaterality of the condition was identified.
These data provide strong evidence of better survival outcomes in FES using the MC/LC plication and LTS procedures in comparison with the FTWE procedure. On the basis of experience from our unit, we recommend that the FTWE procedure be avoided as a form of treatment for FES in favor of the MC/LC plication, LTS, or medial tarsal strip procedure.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
确定并描述 1995 年以来在 Moorfields 眼科医院治疗眼睑松弛综合征（FES）中使用的不同手术程序，并评估其疗效。
横断面研究。
共招募了 71 名在 Moorfields 眼科医院接受了 13 年 FES 手术的患者。还纳入了 7 名患者的回顾性数据，共有 78 名患者的数据。
患者接受全面的眼部检查。通过为每种手术绘制 Kaplan-Meier 曲线来确定生存分析。使用对数秩检验比较生存趋势。使用敏感性分析和允许聚类的 Cox 回归分析来调查该条件的双侧性引起的偏倚的可能影响。使用 Fisher 确切检验进行外科医生偏倚的检验。
病情复发。两名独立观察者对患者接受的手术类型进行了临床评估，结果进行了盲法评估。
共发现四种不同形式的手术治疗：（1）全层楔形切除（FTWE）（26 例，33 例）；（2）上睑外侧睑板条（LTS）（31 例，43 例）；（3）内侧和外侧眦（MC 和 LC）折叠术（15 例，19 例）；（4）内侧睑板条（6 例，6 例）。共有 101 例手术中的 44 例失败。LC/MC 折叠术（P = 0.003）和上睑 LTS 术（P = 0.001）的长期生存结果明显优于 FTWE。然而，LC/MC 折叠术与 LTS 组之间的生存比较未达到显著性（P = 0.37）。在经验相当的外科医生组之间，未发现结果存在显著差异（P = 0.18）。未发现该疾病双侧性引起的偏倚。
这些数据提供了强有力的证据，表明在 Moorfields 眼科医院，与 FTWE 手术相比，MC/LC 折叠术和 LTS 手术在治疗 FES 中具有更好的生存结果。根据我们科室的经验，我们建议避免使用 FTWE 手术作为 FES 的治疗形式，而倾向于使用 MC/LC 折叠术、LTS 或内侧睑板条手术。
作者没有与本文讨论的任何材料有关的专有或商业利益。
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