Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2011 Nov-Dec;27(6):447-52. doi: 10.1097/IOP.0b013e3182286962.
To report the outcomes of a technique for correcting lower-eyelid retraction with composite recession of the inferior retractor and orbital septum complex, release of the lateral horn of the lower-eyelid retractors, and the orbito-malar ligament (OML) followed by skin, orbicularis, and conjunctival advancement.
We performed a retrospective, noncomparative review of consecutive procedures performed on patients with lower-eyelid retraction undergoing composite septo-retractor recession for lower-eyelid retraction over a 4-year period, performed or supervised by a single surgeon (RM). Outcomes are based on postoperative standard photographs, including central pupil to lower-eyelid distance, inferior scleral show, and subjective improvement in lower-eyelid lateral flare.
We reviewed 26 eyes of 16 patients (12 men, 4 women; mean age, 61.0 ± 14.3 years). Causes of lower-eyelid retraction included involutional (n = 6), thyroid orbitopathy (n = 4), previous lower-eyelid surgery (n = 3), mechanical secondary to proptosis (n = 1), Crouzon syndrome (n = 1), and longstanding facial nerve palsy (n = 1). Mean lower-eyelid elevation achieved was 1.4 mm ± 1.3 mm (range, 0.2 to 6.6 mm; p = 0.001). Scleral show improved by 1.0 ± 0.7 mm (range, 0.0 to 2.9; p = <0.001). Preoperatively, all patients had an altered lower-eyelid contour with lateral flare, 89% cases being graded "significant." Lower-eyelid contour improved postoperatively, with only 19% graded "significant" lateral flare (p = <0.0001). No significant complications occurred, although one patient required excision of a secondary lateral canthal cyst.
Composite recession of the inferior retractor and orbital septum complex combined with release of the inferior retractor lateral horn and the OML significantly improves lower-eyelid height and contour in cases of lower-eyelid retraction and should be considered a useful option for this condition.
报告一种通过复合下睑退缩矫正术治疗下睑退缩的技术的结果，该技术包括下睑缩肌和眶隔复合体的复合退缩、下睑退缩外侧角的释放以及眶颧韧带（OML）的后退，随后进行皮肤、眼轮匝肌和结膜的推进。
我们对 4 年来由一位外科医生（RM）独立或监督进行的下睑退缩复合下睑缩肌和眶隔复合体退缩术治疗下睑退缩的连续手术进行了回顾性、非对照研究。结果基于术后标准照片，包括瞳孔至下睑距离、下巩膜暴露和下睑外侧膨出的主观改善。
我们回顾了 16 名患者（12 名男性，4 名女性；平均年龄 61.0±14.3 岁）的 26 只眼。下睑退缩的原因包括退行性（n=6）、甲状腺眼病（n=4）、下睑手术既往史（n=3）、机械性继发于眼球突出（n=1）、Crouzon 综合征（n=1）和长期面神经麻痹（n=1）。平均下睑提升高度为 1.4mm±1.3mm（范围 0.2-6.6mm；p=0.001）。巩膜暴露改善了 1.0mm±0.7mm（范围 0.0-2.9mm；p<0.001）。术前，所有患者的下睑轮廓均有外侧膨出改变，89%的病例被评为“显著”。术后下睑轮廓改善，仅有 19%的病例被评为“显著”外侧膨出（p<0.0001）。无明显并发症发生，尽管有 1 例患者需要切除继发性外侧泪囊囊肿。
下睑缩肌和眶隔复合体的复合退缩，结合下睑退缩外侧角的释放和 OML 的后退，显著改善了下睑退缩的下睑高度和轮廓，对于下睑退缩的治疗应考虑作为一种有用的选择。
