Lisman R D, Jakobiec F A, Small P
Department of Ophthalmology, Manhattan Eye, Ear & Throat Hospital, New York.
Ophthalmology. 1989 Jul;96(7):1021-6. doi: 10.1016/s0161-6420(89)32798-9.
The extension of sebaceous carcinoma of the eyelid within the epithelium of the palpebral, forniceal, and bulbar conjunctiva (pagetoid spread) is a frequent indication for exenteration, but this recommendation is controversial. Six patients with upper eyelid tumors and variable degrees of epibulbar pagetoid extension were treated without exenteration. All underwent wide local resections of their upper eyelids (repaired by Cutler-Beard procedures), with adjunctive cryotherapy to the involved epibulbar surfaces after preoperative map biopsies of the conjunctiva had been done. Cryotherapy was applied during the second-stage Cutler-Beard procedure after initial resection of the tumor bulk. Follow-ups ranging from 12 to 50 months, with conjunctival biopsies at 6-month intervals, showed no recurrence of pagetoid tumor. Although exenteration was avoided, dry-eye symptoms, symblepharon, corneal erosion, and vascularization were side effects, which the patients were willing to tolerate to avoid radical surgery. The complications were most severe in the two patients who were either elderly or had more than two quadrants of epibulbar pagetoid disease.
睑板、穹窿部和球结膜上皮内睑皮脂腺癌的扩展（派杰样扩散）是眼眶内容剜除术的常见指征，但这一建议存在争议。6例患有上睑肿瘤且伴有不同程度眼球表面派杰样扩展的患者未接受眼眶内容剜除术治疗。所有患者均接受了上睑广泛局部切除术（采用卡特 - 比尔德手术修复），并在术前对结膜进行地图活检后，对受累的眼球表面进行辅助冷冻治疗。冷冻治疗在肿瘤大块切除后的二期卡特 - 比尔德手术中进行。随访时间为12至50个月，每6个月进行结膜活检，结果显示派杰样肿瘤无复发。尽管避免了眼眶内容剜除术，但干眼症状、睑球粘连、角膜糜烂和血管化是副作用，患者为避免根治性手术愿意忍受这些副作用。并发症在老年患者或眼球表面派杰样病变超过两个象限的两名患者中最为严重。
