Nakauchi Kazuaki, Mimura Osamu
Ophthalmology, Hyogo College of Medicine, Hyogo, Japan.
Clin Ophthalmol. 2012;6:831-6. doi: 10.2147/OPTH.S31122. Epub 2012 May 31.
The Asian race has a high prevalence of congenital entropion. It was reported that over 20% of Japanese children have congenital entropion at the age of 1 year. One of the structural causes of this condition is the development of epiblepharon, which attaches the lower eyelid to the upper eyelid, and is also common among Asians. However, designing a procedure for modifying an epicanthus flap is relatively difficult, and epicanthoplasty is not a popular procedure in Japan. In the present study, we developed an easy method of designing the surgery, and we describe both the surgical procedure and the outcome.
Between January 2010 and August 2011, one surgeon performed surgery to correct congenital entropion in 28 patients. We analyzed this series of 28 cases retrospectively. The patients consisted of 17 females and eleven males with an average age of 7.6 years. Ten patients with a thick epicanthal fold required epicanthoplasties in addition to lower lid procedures, and 18 patients with a thin epicanthal fold required only lower lid procedures.
On the epicanthus, a small, triangular "fish-tail" flap that was 2 mm wide was designed and was located adjacent to a "fish-body" marking on the subciliary lower eyelid. After fish-tail resection, the residual medial edge was sutured to the corner of the epicanthus. A C-shaped epicanthus was changed into an L-shape by means of this procedure.
The fish-tail resection diminished the tension of the orbicularis in the superior direction. After a minimum of 6 months, the shape of the medial canthus remained L-shaped, and the cilia had stable orientations.
This plasty is easy to design in conjunction with a Hotz procedure, and it is an effective means of correcting Asian congenital entropion. Recognizing the shape of a congenital entropion that is accompanied by epiblepharon is important for its radical treatment.
亚洲人种先天性睑内翻的患病率较高。据报道，超过20%的日本儿童在1岁时患有先天性睑内翻。这种情况的结构原因之一是内眦赘皮的形成，它将下眼睑与上眼睑相连，在亚洲人中也很常见。然而，设计一种修改内眦赘皮瓣的手术方法相对困难，而且内眦成形术在日本并不是一种常见的手术。在本研究中，我们开发了一种简单的手术设计方法，并描述了手术过程和结果。
2010年1月至2011年8月期间，一名外科医生对28例先天性睑内翻患者进行了矫正手术。我们对这28例病例进行了回顾性分析。患者包括17名女性和11名男性，平均年龄为7.6岁。10例内眦赘皮较厚的患者除下睑手术外还需要进行内眦成形术，18例内眦赘皮较薄的患者仅需要进行下睑手术。
在内眦赘皮上，设计一个宽2毫米的小三角形“鱼尾”瓣，位于下睑睫毛下的“鱼身”标记附近。切除鱼尾瓣后，将残留的内侧边缘缝合到内眦赘皮的角上。通过该手术，将C形内眦赘皮变为L形。
鱼尾瓣切除减少了眼轮匝肌向上的张力。至少6个月后，内眦的形状保持为L形，睫毛方向稳定。
这种成形术易于与霍茨手术联合设计，是矫正亚洲人先天性睑内翻的有效方法。认识伴有内眦赘皮的先天性睑内翻的形状对其根治很重要。
