Ma Shang-Te, Liu Yao-Lin, Hsieh Ching-Ju, Chen Yo-Shen, Tsai Tzu-Hsun
Department of Ophthalmology, Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
Department of Ophthalmology, National Taiwan University Hospital, College of Medicine National Taiwan University, Taipei, Taiwan.
J Ophthalmol. 2020 Dec 5;2020:5073895. doi: 10.1155/2020/5073895. eCollection 2020.
To identify an appropriate surgical indication of epiblepharon by comparing keratopathy and astigmatism outcomes after surgical and medical treatments for epiblepharon in Asian children.
Children diagnosed with epiblepharon ( = 82, age 5.93 ± 2.76 years) with >6 months of follow-up were enrolled. The clinical presentations and cycloplegic refractive status at the baseline and 3 and 6 months after treatment were compared between surgical (91 eyes from 47 children) and nonsurgical (67 eyes from 35 children) groups. The refractive and keratometric astigmatism at each time point were evaluated with vector analysis methods. For Thibos and Horner's method, the astigmatic power vector was decomposed into horizontal and oblique meridians ( and ). However, the treatment-induced astigmatism (TIA) vectors were calculated by Alpins' method and depicted by the AstigMATIC software.
In the surgical and nonsurgical groups, the baseline astigmatism magnitude was similar (2.22 ± 1.39 and 2.26 ± 1.46 , = 0.87). The rate of complete resolution of keratopathy at 6 months was 71.4% and 11.5%. The astigmatism magnitude in the surgical group differed among baseline and 3 months (2.25 ± 1.23 ) and 6 months postoperatively (1.97 ± 1.28 ) ( = 0.001). Power vector analyses confirmed a nuanced against-the-rule shift in the surgical group. This trend was especially observed in the subgroup of baseline astigmatism >2.0 . However, the difference in the astigmatism magnitude between surgical and nonsurgical groups, even in highly astigmatic children, was not significant at 6 months.
The improvement of keratopathy in the surgical group was greater than that in the nonsurgical group in consideration of the more advanced severity in the surgery group at baseline. Decreased with-the-rule astigmatism can be observed at 6 months postoperatively, particularly among those with greater baseline astigmatism. However, the amount of change is small, and the outcome does not differ significantly from the nonsurgical treatment. Therefore, surgical indications should majorly base on the severity of symptoms and keratopathy.
通过比较亚洲儿童睑裂斑手术和非手术治疗后的角膜病变和散光结果，确定睑裂斑合适的手术指征。
纳入诊断为睑裂斑的儿童（n = 82，年龄5.93±2.76岁），随访时间>6个月。比较手术组（47例儿童的91只眼）和非手术组（35例儿童的67只眼）在基线、治疗后3个月和6个月时的临床表现及睫状肌麻痹验光状态。使用矢量分析方法评估每个时间点的屈光性散光和角膜散光。对于Thibos和Horner方法，散光矢量被分解为水平和斜子午线（ 和 ）。然而，治疗性散光（TIA）矢量通过Alpins方法计算，并由AstigMATIC软件描绘。
手术组和非手术组的基线散光量相似（2.22±1.39和2.26±1.46 ，P = 0.87）。6个月时角膜病变完全消退的比例分别为71.4%和11.5%。手术组的散光量在基线与术后3个月（2.25±1.23 ）和6个月（1.97±1.28 ）之间存在差异（P = 0.001）。矢量分析证实手术组有细微的逆规散光偏移。这种趋势在基线散光>2.0 的亚组中尤为明显。然而，即使在高度散光的儿童中，手术组和非手术组在6个月时的散光量差异也不显著。
考虑到手术组基线时病情更严重，手术组角膜病变的改善大于非手术组。术后6个月可观察到顺规散光减少，尤其是基线散光较大者。然而，变化量较小，与非手术治疗的结果差异不显著。因此，手术指征应主要基于症状和角膜病变的严重程度。
