Jung Ji Won, Kwon Kye Yoon, Choi Deana Lynn, Kim Tae-Im, Kim Eung Kweon, Seo Kyoung Yul
*Department of Ophthalmology, Severance Hospital, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea; †Department of Ophthalmology and Visual Sciences, School of Medicine, Washington University, St. Louis, MO; and ‡Institute of Vision Research, Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea.
Cornea. 2015 Mar;34(3):308-12. doi: 10.1097/ICO.0000000000000326.
The aim of this study was to investigate long-term clinical outcomes of conjunctival flap surgery for calcified scleromalacia after periocular surgery.
We examined 73 surgical sites (nasal and/or temporal area) in 60 eyes from 43 patients who underwent conjunctival flap surgery for calcified scleromalacia arising from cosmetic wide conjunctivectomy or pterygium excision. Clinical outcomes, including the need for reoperation and development of complications, were evaluated over a long-term follow-up period. Morphological evaluations of the surgical area at final follow-up were performed using a total score for injection severity, ocular surface smoothness, and choroid visibility, and patients subjectively evaluated their cosmetic outcome using a scale of 0 (very poor) to 4 (excellent).
The mean follow-up duration after final conjunctival flap surgery was 26.5 ± 6.8 months (range, 15-52 months). There were no cases of progressive scleral thinning or serious complications such as flap necrosis or scleral perforation. Only 3 surgical areas with an inferior flap required additional flap placement because of avascular sclera exposure. Minor complications such as conjunctival cyst, edematous flap, vessel engorgement, and flap hypertrophy were easily treated or spontaneously improved. Mean morphological score was 2.2 and cosmetic outcome score was 2.9, indicating almost "good" outcomes.
Based on our long-term experience, we propose that conjunctival flap surgery may be a safe and satisfactory treatment for complicated calcified scleromalacia after periocular surgery.
本研究旨在探讨眼周手术后钙化性巩膜软化症结膜瓣手术的长期临床疗效。
我们检查了43例患者60只眼中的73个手术部位（鼻侧和/或颞侧区域），这些患者因美容性广泛结膜切除术或翼状胬肉切除术导致钙化性巩膜软化症而接受了结膜瓣手术。在长期随访期间评估临床疗效，包括再次手术的必要性和并发症的发生情况。在最终随访时，使用充血严重程度、眼表平滑度和脉络膜可见度的总分对手术区域进行形态学评估，患者使用0（非常差）至4（优秀）的量表主观评估其美容效果。
最终结膜瓣手术后的平均随访时间为26.5±6.8个月（范围15 - 52个月）。没有出现进行性巩膜变薄或严重并发症，如瓣坏死或巩膜穿孔。只有3个下瓣手术区域因无血管巩膜暴露需要额外放置瓣。结膜囊肿、瓣水肿、血管充血和瓣肥大等轻微并发症易于治疗或自行改善。平均形态学评分为2.2，美容效果评分为2.9，表明几乎为“良好”效果。
基于我们的长期经验，我们认为结膜瓣手术可能是眼周手术后复杂性钙化性巩膜软化症的一种安全且令人满意的治疗方法。
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