Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India.
Indian J Ophthalmol. 2022 Dec;70(12):4470. doi: 10.4103/ijo.IJO_1504_22.
Severe cicatricial entropion in Stevens-Johnson syndrome (SJS) patients is difficult to treat and is associated with a higher recurrence rate. Also, entropion in the presence of lid margin mucous membrane graft (MMG) further complicates the surgical anatomy and approach.
To report a modified surgical technique of repairing severe upper eyelid cicatricial entropion in an SJS patient with history of lid margin MMG.
Cicatricial entropion in patients with SJS is entirely different from trachomatous cicatricial entropion. The involvement of the lid margin with keratinization, tarsal scarring, persistent conjunctival inflammation, and unhealthy ocular surface affects the surgical approach and outcomes. Conjunctiva-sparing surgery with reconstruction of the lid margin using MMG, flattening and repositioning the anterior lamella, and covering the bare tarsus with MMG rather than leaving it raw are the necessary modifications in this technique from conventional anterior lamellar recession. The video demonstrates the surgical technique for harvesting and preparation of a labial MMG, the splitting of the anterior and posterior lamella of the lid margin, scar tissue release between the lash line and the tarsus, repositioning of the anterior lamella, and anchoring of the labial MMG.
Anterior lamellar recession combined with MMG wrapping the lid margin and bare tarsus offers good cicatricial entropion repair outcomes. Removal of fat and submucosa from the mucosal graft should be done for better cosmesis. Adequate separation of the scar tissues from the lash line and the tarsus is essential.
史蒂文斯-约翰逊综合征（SJS）患者的严重瘢痕性睑内翻难以治疗，且复发率较高。此外，在存在睑缘黏膜移植物（MMG）的情况下发生睑内翻会使手术解剖和方法进一步复杂化。
报告一种改良的手术技术，用于修复曾行睑缘 MMG 的 SJS 患者的严重上眼睑瘢痕性睑内翻。
SJS 患者的瘢痕性睑内翻与沙眼性瘢痕性睑内翻完全不同。睑缘的角化、睑板瘢痕、持续的结膜炎症和不健康的眼表面的参与会影响手术方法和结果。保留结膜的手术，使用 MMG 重建睑缘，使前部睑板变平并重新定位，并用 MMG 覆盖裸露的睑板而不是使其裸露，这些是该技术相对于传统的前部睑板退缩术的必要修改。该视频演示了用于获取和准备唇黏膜 MMG 的手术技术，分离睑缘的前、后层，在睫毛线和睑板之间松解瘢痕组织，重新定位前部睑板，以及将唇黏膜 MMG 固定。
前部睑板退缩术联合 MMG 包裹睑缘和裸露的睑板可获得良好的瘢痕性睑内翻修复效果。为了更好的美容效果，应从黏膜移植物中去除脂肪和黏膜下组织。从睫毛线和睑板充分分离瘢痕组织至关重要。
