Ehrhardt A, Guechi O, Zaidi M, Sot M, Lhuillier L, Houmad N, Ouamara N, Goetz C, Perone J-M
Department of Ophthalmology, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, 57085 Metz cedex 03, France.
Clinical Research Support Unit, Metz-Thionville Regional Hospital Center, Mercy Hospital, Metz, France.
J Fr Ophtalmol. 2018 Oct;41(8):752-758. doi: 10.1016/j.jfo.2017.12.018. Epub 2018 Sep 11.
To compare the efficacy of two surgical techniques-lateral tarsal strip (canthoplasty) alone, and lateral tarsal strip with three-snip punctoplasty-in reducing epiphora arising from involutional ectropion with partial punctal stenosis.
Fourty patients with involutional ectropion and partial stenosis of the lacrimal punctum were randomly allocated to two treatment groups. Group 1 patients received lateral tarsal strip alone with only non-invasive stenting of the punctum, and group 2 patients received tarsal strip plus three-snip punctoplasty. Subjective assessment of epiphora was achieved via completion of a quality of life (QoL) questionnaire preoperatively and at postoperative month 3. Eyelid position, adverse outcomes and corneal dryness (via Oxford grading scheme) were also assessed postoperatively. Only patients with unilateral problems were included in the study.
Forty eyes of 40 patients were included: 20 in each group. The mean ages of group 1 and group 2 patients were 79±11 and 80±9 years, respectively. All patients reported significantly reduced eye watering after surgery, with no significant intergroup difference in subjective outcomes, except that computer usage and night driving (P<0.05), improved in a more significant way in group 2. Eyelid malposition was corrected in all cases, there were no cases of postoperative punctal eversion, and no significant adverse events or complications occurred. Finally, the mean improvements in the dryness/keratitis score (using the Oxford scheme) were comparable between the 2 groups (P=0.34).
The study findings indicate that treatment of involutional ectropion with partial punctal stenosis by lateral tarsal strip with three snip punctoplasty does not provide greater reduction in discomfort secondary to epiphora than conventional lateral tarsal strip alone, except for specific situations such as night driving or computer use.
比较两种手术技术——单纯外侧睑板条（睑裂成形术）和外侧睑板条联合三点式泪点成形术——在减少因退行性睑外翻伴部分泪点狭窄引起的溢泪方面的疗效。
40例患有退行性睑外翻和泪点部分狭窄的患者被随机分配到两个治疗组。第1组患者仅接受外侧睑板条手术，泪点仅采用非侵入性支架支撑，第2组患者接受睑板条联合三点式泪点成形术。通过术前及术后3个月完成生活质量（QoL）问卷对溢泪进行主观评估。术后还评估了眼睑位置、不良结局和角膜干燥情况（通过牛津分级方案）。本研究仅纳入单侧问题的患者。
纳入40例患者的40只眼，每组20只。第1组和第2组患者的平均年龄分别为79±11岁和80±9岁。所有患者术后均报告眼部分泌物明显减少，主观结局组间无显著差异，只是在第2组中，使用电脑和夜间驾驶方面（P<0.05）改善更为显著。所有病例的眼睑位置异常均得到纠正，无术后泪点外翻病例，未发生显著不良事件或并发症。最后，两组间干燥/角膜炎评分（采用牛津方案）的平均改善情况相当（P=0.34）。
研究结果表明，对于伴有部分泪点狭窄的退行性睑外翻，外侧睑板条联合三点式泪点成形术在减轻溢泪继发的不适方面，并不比单纯传统外侧睑板条手术有更大改善，除了夜间驾驶或使用电脑等特定情况。
