Goldberg R A, Lessner A M, Shorr N, Baylis H I
Division of Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles School of Medicine 90024-7006.
Ophthalmic Plast Reconstr Surg. 1990;6(4):241-6. doi: 10.1097/00002341-199012000-00003.
The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. We prospectively observed 25 patients undergoing transconjunctival blepharoplasty and orbital floor surgery. Fornix depth, eyelid margin position, and the presence or absence of eyelid retraction were measured preoperatively and at each postoperative visit. No significant permanent change in these parameters was observed. Temporary entropion was observed in two patients; this resolved with conservative treatment. On self-limited suture granuloma was observed. In a subgroup of six patients, the conjunctival incision was closed on one side and left unclosed on the other. No adverse healing was noted on the unclosed side. We conclude that the transconjunctival approach is associated with a low incidence of complications, and that it does not significantly alter the fornix depth or eyelid margin position. A skin incision is avoided. The inferior orbital septum is not violated, greatly reducing the risk of development of lower eyelid retraction.
经结膜入路处理眶下缘和眶脂肪具有避免在下睑皮肤和前层形成瘢痕的潜在优势。该入路的并发症，包括结膜穹窿缩短和睑缘错位，偶尔有报道。我们前瞻性观察了25例行经结膜睑成形术和眶底手术的患者。术前及术后每次随访时测量穹窿深度、睑缘位置以及有无睑退缩。这些参数未观察到明显的永久性改变。两名患者出现暂时性睑内翻，经保守治疗后缓解。观察到一例自限性缝线肉芽肿。在一个6例患者的亚组中，结膜切口一侧缝合而另一侧未缝合。未缝合侧未发现不良愈合情况。我们得出结论，经结膜入路并发症发生率低，且不会显著改变穹窿深度或睑缘位置。避免了皮肤切口。未破坏眶下隔膜，大大降低了下睑退缩发生的风险。
