Czyz Craig N, Wulc Allan E, Ryu Christina L, Foster Jill A, Edmonson Barbara C
*Division of Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth Doctor's Hospital, Columbus, Ohio; †Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, Ohio; ‡Department of Ophthalmology and Otolaryngology, Drexel University College of Medicine, Philadelphia, Pennsylvania; §Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania; ‖Department of Medical Education, The Ohio State University School of Medicine, Columbus, Ohio, U.S.A.
Ophthalmic Plast Reconstr Surg. 2015 Jan-Feb;31(1):34-7. doi: 10.1097/IOP.0000000000000178.
To describe a surgical technique for repair of medial ectropion that simply and reliably addresses tendinous laxity and punctal eversion.
Prospective, single-blind, consecutive case study of 54 patients (79 eyes) by 3 surgeons. The subject population consisted of 33 males and 21 females, with a mean age of 81 years (SD = 9, range = 64-97). The presenting mechanisms of ectropion were as follows: cicatricial (n = 10), paralytic (n = 1), involutional (n = 62), mechanical (n = 3), and congenital (n = 3). Ectropion and punctal eversion was surgically addressed by use of a purse string suture that incorporated closure of a medial spindle incision and deep fixation to the base of the caruncle.
The average postoperative follow-up period was 147 days (SD = 291, range 8-2,352). Sixty-four eyes had a presenting complaint of tearing (81%), with 50 eyes (78%) achieving complete resolution (p = 0.0001). Eyelid malposition was determined to be anatomically corrected in 34 of 35 eyes (97%, p = 0.0001). Four of the 79 operated eyelids had recurrence of ectropion (5%). All other reported complications were minor, resolved without sequalae.
The technique demonstrated safety, efficacy, and reproducibility, regardless of ectropion mechanism. Incorporation of a purse string suture between the lower eyelid portion of the medial canthal tendon and the caruncle produces a reliable posterior-superior fixation parallel to the vectors of the posterior limb of the medial canthal tendon. This technique is equally effective as a primary correction method or when used in combination with other procedures.
描述一种修复内侧睑外翻的手术技术，该技术能简单且可靠地解决肌腱松弛和泪点外翻问题。
3位外科医生对54例患者（79只眼）进行前瞻性、单盲、连续病例研究。研究对象包括33名男性和21名女性，平均年龄81岁（标准差=9，范围=64 - 97岁）。睑外翻的表现机制如下：瘢痕性（n = 10）、麻痹性（n = 1）、退行性（n = 62）、机械性（n = 3）和先天性（n = 3）。通过使用荷包缝合术来解决睑外翻和泪点外翻，该缝合术包括闭合内侧纺锤形切口并深层固定于泪阜基部。
术后平均随访期为147天（标准差=291，范围8 - 2352天）。64只眼有流泪主诉（81%），其中50只眼（78%）完全缓解（p = 0.0001）。35只眼中有34只眼的眼睑位置异常在解剖学上得到纠正（97%，p = 0.0001）。79只手术眼睑中有4只出现睑外翻复发（5%）。所有其他报告的并发症均较轻微，无后遗症而自行缓解。
无论睑外翻机制如何，该技术均显示出安全性、有效性和可重复性。在内眦肌腱下睑部分与泪阜之间采用荷包缝合可产生可靠的后上固定，平行于内眦肌腱后肢的向量。该技术作为一种主要矫正方法或与其他手术联合使用时同样有效。
