Galindo-Ferreiro Alicia, Akaishi Patricia Santello, Al-Aliwi Mohammad, Niespodzany Eric, Gálvez-Ruiz Alberto, Cruz Antonio Augusto Velasco
a King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.
b Complejo Hospitalario , Palencia , Spain.
Semin Ophthalmol. 2017;32(5):642-646. doi: 10.3109/08820538.2016.1143517. Epub 2016 Jul 1.
To evaluate the efficacy of total Tenon-conjunctival flaps (TCFs) for coverage of phthisical eyes with normal corneal sensitivity.
A retrospective chart review was performed on 142 patients with mild monocular phthisis who underwent the TCF procedure to allow monocular scleral shell fitting at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. All patients had normal corneal sensation in their painless phthisical eye and were intolerant to cosmetic scleral shell fitting preoperatively. Consecutive patients over a five-year period were enrolled. Data were collected on functional success, duration of follow-up, and complications. The Tenon's and conjunctival layers were closed separately in 103 eyes and as a single layer in the remaining 39 eyes. Main outcome measures were functional success, defined as tolerance to the prosthetic scleral shell, and rate of postoperative complications such as wound retraction, epithelial cysts, and blepharoptosis. Fisher's exact test was used to analyze the association between the main outcome measures and type of flap closure.
The mean duration of follow-up was 23.7±17.43 months. Functional success was achieved in 98.6% of eyes. Minor complications included epithelial inclusion cysts in 10 (7.04%) eyes and mild blepharoptosis in 9 (6.34%) eyes. Overall flap retraction was noted in 14 (9.86%) eyes. This complication occurred in 13 of 103 (33.3%) eyes with double layer closure and in 1 of 39 (0.97%) eyes with a single layer flap closure (p=0.11).
TCF is an effective procedure to increase corneal thickness for coverage in phthisical eyes with positive corneal sensation. The incorporation of Tenon's capsule in the flap did not increase complications with a frequency similar to the classic Gundersen procedure.
评估全眼球筋膜-结膜瓣（TCF）覆盖角膜感觉正常的眼球痨性眼球的疗效。
对沙特阿拉伯利雅得国王哈立德眼科专科医院142例行TCF手术以进行单眼巩膜壳配戴的轻度单眼眼球痨患者进行回顾性病历分析。所有患者无痛性眼球痨患眼的角膜感觉均正常，且术前不耐受美容性巩膜壳配戴。纳入连续5年的患者。收集功能成功情况、随访时间及并发症的数据。103只眼的眼球筋膜层和结膜层分别关闭，其余39只眼作为单层关闭。主要观察指标为功能成功，定义为对义眼巩膜壳的耐受性，以及术后并发症发生率，如伤口回缩、上皮囊肿和上睑下垂。采用Fisher精确检验分析主要观察指标与瓣关闭类型之间的关联。
平均随访时间为23.7±17.43个月。98.6%的患眼获得功能成功。轻微并发症包括10只眼（7.04%）出现上皮植入性囊肿，9只眼（6.34%）出现轻度上睑下垂。共14只眼（9.86%）出现瓣回缩。该并发症在103只双层关闭的眼中有13只（33.3%）发生，在39只单层瓣关闭的眼中有1只（0.97%）发生（p=0.11）。
TCF是一种有效的手术方法，可增加角膜厚度，用于覆盖角膜感觉阳性的眼球痨性眼球。瓣中纳入眼球筋膜囊并未增加与经典Gundersen手术频率相似的并发症。
