Binotti William W, Aguiar Ana Carla B de, Barbosa Aline A, Burnier Sergio V
Ophthalmology Department, Complexo Hospitalar Ouro Verde "Prefeito Edivaldo Orsi", Campinas, SP, Brazil.
Arq Bras Oftalmol. 2023 Jan-Feb;86(1):52-59. doi: 10.5935/0004-2749.20230010.
The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue.
A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups.
Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%.
The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>.
本研究旨在评估采用改良的板层间口腔黏膜移植手术技术（使用纤维蛋白胶）治疗倒睫患者的长期疗效。
在欧鲁韦尔德综合医院眼科整形科进行了一项前瞻性研究。对常规治疗无效的复发性倒睫且无睑内翻的患者，行睑缘间板层劈开并植入口腔黏膜移植物，用纤维蛋白胶替代缝线。然后在术后1天、1周、1个月、6个月和4年进行随访。在6个月和4年随访时评估移植物粘连情况、症状缓解情况、美观满意度、患者总体满意度以及倒睫复发情况。
纳入15例患者（共19只眼），其中女性10例（66.7%），男性5例（33.3%）。平均年龄为75.4±10.5岁（范围54 - 98岁）。后天性倒睫是主要病因。在后天性倒睫患者中，12例（86.7%）患有慢性睑缘炎，2例（13.3%）病因不明，1例（6.7%）患有沙眼性倒睫。大多数病例仅累及一个眼睑节段（89.4%）且睫毛数量≤5根（84.2%；轻度倒睫）。未报告纤维蛋白胶的不良反应，移植物植入后无需缝线。6个月时，未发生移植物失败，13例患者的17只眼（89.4%）移植物粘连良好，2例患者的2只眼（10.5%）移植物部分粘连，1例患者的2只眼（10.5%）倒睫复发。4年随访时，未发生移植物失败，3例患者（3只眼）失访，2例患者的2只眼（14.2%）倒睫复发。4年累积成功率为78.9%。
使用纤维蛋白胶的改良板层间手术显示出良好的长期成功率。该技术缩短了手术时间，便于植入较小的移植物，因此，对于难治性轻度倒睫且无睑内翻的情况应予以考虑。
