McGrath Lindsay A, McNab Alan A
University of Queensland, Brisbane, QLD, Australia.
Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia.
Graefes Arch Clin Exp Ophthalmol. 2018 Dec;256(12):2437-2441. doi: 10.1007/s00417-018-4090-x. Epub 2018 Aug 1.
Conjunctival chemosis is a common, usually benign, complication of ocular and oculoplastic surgery. After enucleation, evisceration, or secondary ball implant, however, conjunctival edema can cause conformer extrusion, forniceal eversion, and shortening which may complicate the future fitting of a prosthesis. This longitudinal chart review aimed to estimate the efficacy of a temporary suture tarsorrhaphy to minimize postoperative edema and improve conformer retention.
We retrospectively reviewed the charts of 415 consecutive patients undergoing enucleation, evisceration, and secondary ball implantation between 1990 and 2016. Three-hundred twenty-eight patients had complete data which was analyzed for age, gender, surgical details, complications, and follow-up.
We identified 328 eyes that underwent enucleation (48%), evisceration (3%), or secondary implantation (49%) during the study period. Eighty-nine patients had a suture tarsorrhaphy at the time of surgery, and 239 did not. There was a statistically significant incidence of postoperative conjunctival edema in the no tarsorrhaphy group. There was also a significantly increased rate of conformer loss associated with conjunctival edema. Need for further surgery was not uncommon with 64% and 43% of patients requiring a secondary procedure in the no tarsorrhaphy and tarsorrhaphy groups respectively.
Temporary suture tarsorrhaphy is a simple and effective procedure that reduces conjunctival edema and increases conformer stability when performed at the time of enucleation, evisceration, or secondary ball implantation.
结膜水肿是眼科和眼整形手术常见的、通常为良性的并发症。然而，眼球摘除术、眼内容剜出术或二期义眼座植入术后，结膜水肿可导致义眼座脱出、穹窿结膜外翻和缩短，这可能会使未来义眼的佩戴变得复杂。本纵向图表回顾旨在评估临时缝线睑裂缝合术在减轻术后水肿和提高义眼座固定效果方面的疗效。
我们回顾性分析了1990年至2016年间连续415例行眼球摘除术、眼内容剜出术和二期义眼座植入术患者的病历。328例患者有完整数据，对其年龄、性别、手术细节、并发症及随访情况进行分析。
在研究期间，我们共确定了328只接受眼球摘除术（48%）、眼内容剜出术（3%）或二期义眼座植入术（49%）的眼睛。89例患者在手术时进行了缝线睑裂缝合术，239例未进行。未行睑裂缝合术组术后结膜水肿发生率有统计学意义。结膜水肿导致的义眼座丢失率也显著增加。两组均有不少患者需要进一步手术，未行睑裂缝合术组和行睑裂缝合术组分别有64%和43%的患者需要二次手术。
临时缝线睑裂缝合术是一种简单有效的手术方法，在眼球摘除术、眼内容剜出术或二期义眼座植入术时进行，可减轻结膜水肿，提高义眼座稳定性。
