Eckstein A, Esser J
Orthoptik, Universitäts-Augenklinik Essen, Essen.
Klin Monbl Augenheilkd. 2011 Oct;228(10):887-91. doi: 10.1055/s-0031-1281775. Epub 2011 Oct 13.
The aim of this study was to compare outcomes of lower lid lengthening with and without an additional temporal tarsorrhaphy.
Lower lid lengthening was performed in 39 patients (16 without tarsorrhaphy [group 1], 23 with tarsorrhaphy [group 2]) via a posterior subtarsal transconjunctival ac-ess. A bovine pericardial transplant (Tutopatch, length = amount of retraction + 4 mm) was placed between the recessed retractors and the tarsus.
Mean preoperative lower lid retraction was 2.3 mm in group 1 and 2.6 mm in group 2 (n. s.). Lower lid lengthening and simultaneous tarsorrhaphy resulted in significantly increased reduction of lower lid retraction: 2.3 mm (1.5 - 4.5) (p = 0.003) compared to patients without tarsorrhaphy: 1.4 mm (0 - 3.0). Patients with tarsorrhaphy presented a higher success rate concerning the elimination of lagophthalmos (success = lagophthalmos ≤ 0.5 mm: 21 / 23 (91.3 %) as opposed to patients without tarsorrhaphy: 8 / 16 (50 %); (p = 0.004). Scleral show was eliminated in 78 % of group 2 in comparison to only 50 % in group 1 (p = 0.06).
Lower lid lengthening should be combined with simultaneous temporal tarsorrhaphy in patients with lower lid retraction exceeding 1.5 mm. The tarsorrhaphy increases the effect of lower lid lengthening by about 1 mm.
本研究旨在比较下睑延长术联合或不联合额外颞侧睑裂缝合术的效果。
通过睑板下经结膜入路对39例患者（16例未行睑裂缝合术[第1组]，23例行了睑裂缝合术[第2组]）进行下睑延长术。将一片牛心包移植片（Tutopatch，长度 = 退缩量 + 4 mm）置于退缩的睑板肌与睑板之间。
第1组术前平均下睑退缩为2.3 mm，第2组为2.6 mm（无统计学差异）。下睑延长术联合睑裂缝合术使下睑退缩的改善程度显著增加：与未行睑裂缝合术的患者相比，联合睑裂缝合术患者的下睑退缩减少了2.3 mm（1.5 - 4.5）（p = 0.003），未行睑裂缝合术患者减少了1.4 mm（0 - 3.0）。行睑裂缝合术的患者在消除兔眼方面成功率更高（成功标准为兔眼≤0.5 mm：23例中有21例（91.3%），而未行睑裂缝合术的患者为16例中有8例（50%）；（p = 0.004）。第2组78%的患者消除了巩膜暴露，而第1组仅为50%（p = 0.06）。
下睑退缩超过1.5 mm的患者，下睑延长术应同时联合颞侧睑裂缝合术。睑裂缝合术可使下睑延长术的效果增加约1 mm。
