Moorfields Eye Hospital, City Road, London, England, EC1V 2PD, UK.
Royal Eye Infirmary, Derriford Hospital, Plymouth, England, PL6 8DH, UK.
Eye (Lond). 2021 Mar;35(3):929-935. doi: 10.1038/s41433-020-0998-6. Epub 2020 Jun 3.
To report the outcomes of using a modified Bick's procedure (MBP) combined with a monopedicle myocutaneous flap (MMCF) or full-thickness skin grafting (FTSG) to correct lower eyelid cicatricial ectropion.
A retrospective case-note review of patients undergoing cicatricial ectropion repair between 2012 and 2016 was undertaken. Patient demographics, clinical features, the type of surgery, and outcomes were analysed.
Twenty-four eyelids of 21 treated patients (17 males; 81%) with lower eyelid cicatricial ectropion were identified. They presented at an average age of 79.8 years (median 78; range 58-92). The commonest symptom was epiphora (15 eyelids; 63%), 12 patients (50%) experienced intermittent irritation, and 2(8%) had mucoid discharge. The aetiology included actinic cicatricial ectropion with midface descent (n = 19, 79%), previous tumour resection (n = 3, 13%), trauma (n = 1) and other previous eyelid surgery (n = 1). At a mean follow-up period of 15.3 months (median 6; range 6-52), 22 eyelids (92%) had anatomical success with good cosmesis and two eyelids (8%) had mild residual punctal ectropion. Twenty-one patients (87%) experienced functional success. Comparing the outcomes of MBP + FTSG versus MBP + MMCF, there was no statically significant difference in terms of anatomical (p = 0.48) and functional (p = 1.0) success rates. No cases of failure or recurrence were noted during the follow-up period.
Anterior lamellar deficit ectropion occurs in the absence of overt scarring. It is crucial to fully address both the horizontal laxity and the anterior lamellar deficit associated with such ectropion to minimise the risks of early failure and recurrence. MBP combined with FTSG or MMCF is a safe and effective treatment for such 'cicatricial ectropion' and has a low early recurrence rate.
报告使用改良 Bick 术（MBP）联合单蒂肌皮瓣（MMCF）或全厚皮片移植（FTSG）治疗下眼睑瘢痕性外翻的结果。
回顾性分析 2012 年至 2016 年间接受瘢痕性外翻修复的患者的病历。分析患者的人口统计学、临床特征、手术类型和结果。
共发现 21 例（17 例男性，81%）24 只眼睑下眼睑瘢痕性外翻。患者平均年龄 79.8 岁（中位数 78；范围 58-92）。最常见的症状是溢泪（15 只眼睑；63%），12 例（50%）间歇性刺激，2 例（8%）有黏液样分泌物。病因包括光化性瘢痕性外翻伴中面部下垂（19 例，79%）、既往肿瘤切除（3 例，13%）、外伤（1 例）和其他既往眼睑手术（1 例）。平均随访 15.3 个月（中位数 6；范围 6-52），22 只眼睑（92%）解剖学成功，美容效果良好，2 只眼睑（8%）有轻微的残余泪小点外翻。21 例（87%）功能成功。MBP+FTSG 与 MBP+MMCF 的结果比较，在解剖学（p=0.48）和功能（p=1.0）成功率方面无统计学差异。随访期间无失败或复发病例。
在没有明显瘢痕的情况下，发生前层板缺陷性外翻。充分解决此类外翻的水平松弛和前层板缺陷对于降低早期失败和复发的风险至关重要。MBP 联合 FTSG 或 MMCF 是治疗此类“瘢痕性外翻”的安全有效方法，早期复发率低。
