Tao Jeremiah P, Vemuri Swapna, Patel Amy D, Compton Chris, Nunery William R
*Gavin Herbert Eye Institute, University of California-Irvine, Irvine, California, U.S.A.; and †University of Louisville, Louisville, Kentucky, U.S.A.
Ophthalmic Plast Reconstr Surg. 2014 Jul-Aug;30(4):342-5. doi: 10.1097/IOP.0000000000000175.
To evaluate the efficacy of a lateral tarsoconjunctival flap suspension procedure to improve paralytic eyelid malposition.
Retrospective chart review (with photograph and videographic data) of consecutive patients between 2008 and 2013 with permanent unilateral paralytic eyelid malposition treated with a far lateral tarsoconjunctival flap lower eyelid suspension alone or in conjunction with lateral canthoplasty. Upper and lower eyelid position, lagophthalmos, ocular surface disease, patient satisfaction, and cosmesis were recorded before and after intervention. Postoperative complications and subsequent management were also recorded.
A total of 110 patients were identified. Lagophthalmos, ocular surface exposure, exposure keratopathy, and eyelid retraction (both upper and lower) improved in all cases. All patients described an improvement in eye irritation, epiphora, and cosmesis. Patients with a good Bell's reflex exhibited some dynamic function to the lower eyelid on videography. Three (2.7%) eyelids had flap dehiscence that was successfully treated with repeat suturing. Seven (6.4%) patients had symptomatic temporal peripheral vision requiring partial flap takedown. Five (4.5%) patients had pyogenic granulomas excised. Seven (6.4%) patients later had a supplemental medial tarsorrhaphy for medial lagophthalmos.
The lateral tarsoconjunctival flap suspension was highly effective in this series of patients with paralytic eyelid malposition. Improved eyelid position and cosmesis were universal although some patients benefitted from an additional medial tarsorrhaphy. Return of natural upward lower eyelid movement upon eyelid closure was a further benefit in some patients. Temporal vision obstruction was an infrequent side effect and flap dehiscence and granulomas were rare complications.
评估外侧睑板结膜瓣悬吊手术改善麻痹性眼睑错位的疗效。
对2008年至2013年间连续接受单纯外侧睑板结膜瓣下睑悬吊术或联合外眦成形术治疗的永久性单侧麻痹性眼睑错位患者进行回顾性病历审查（包括照片和视频数据）。记录干预前后的上下眼睑位置、兔眼、眼表疾病、患者满意度和美容效果。还记录了术后并发症及后续处理情况。
共确定110例患者。所有病例的兔眼、眼表暴露、暴露性角膜病变及眼睑退缩（上下眼睑均有）均有改善。所有患者均表示眼部刺激、溢泪及美容效果有所改善。Bell反射良好的患者在视频检查中显示下眼睑有一定的动态功能。3只（2.7%）眼睑出现瓣裂开，经再次缝合成功治疗。7例（6.4%）患者出现有症状的颞侧周边视野缺损，需要部分切除瓣。5例（4.5%）患者切除了化脓性肉芽肿。7例（6.4%）患者后来因内侧兔眼进行了补充性内眦睑裂缝合术。
外侧睑板结膜瓣悬吊术在这一系列麻痹性眼睑错位患者中非常有效。尽管一些患者受益于额外的内眦睑裂缝合术，但眼睑位置和美容效果普遍得到改善。部分患者还进一步受益于闭眼时下眼睑自然向上运动的恢复。颞侧视野受阻是罕见的副作用，瓣裂开和肉芽肿是罕见的并发症。
