Dr. Ayşe Dolar Bilge Private Clinic, Caddebostan Mahallesi, Bagdat Caddesi, Simsek Sokak No 2/8 Kadikoy, Istanbul, Turkey.
Int Ophthalmol. 2024 Jul 4;44(1):313. doi: 10.1007/s10792-024-03165-y.
To assess the efficacy of lower eyelid retraction surgery utilizing autologous auricular scapha cartilage (located within the anterior surface groove between the helix and anti-helix) and to present the surgical outcomes in a patient cohort.
Medical records of 21 patients who underwent lower eyelid retraction surgery with scapha cartilage were retrospectively reviewed. Retractions, present for an extended duration (6 months to 20 years), exhibited 1 mm or more inferior scleral show, attributed to prior lower eyelid blepharoplasty, facial palsy, or as a normal anatomical variation. Surgical interventions included lateral canthotomy, cantholysis, incision of the subtarsal conjunctiva-lower eyelid retractors, lower eyelid retractor lysis, cartilage graft suturing to the defect area without conjunctival cover, and tightening of the lateral canthal corner in all patients.
A total of 29 eyelids in 21 patients underwent surgery without intraoperative complications. Over a mean follow-up period of 11 months (range: 6-30 months), lower lid retraction improved in 96.5% of eyelids. Postoperative margin-to-reflex distance measurements (MRD2) significantly decreased compared to preoperative values (p = 0.001; p < 0.01). Average improvements in MRD2-a (midpupil to lower lid) and MRD2-b (lateral limbus to lower lid) were 1.77 ± 0.80 and 2.04 ± 0.81, respectively (p = 0.001; p < 0.01). Four eyelids (4/29) required revision due to canthal corner loosening, with correction necessitating periosteal flaps. All four patients had previously undergone two or more repairs elsewhere. The graft was visible in two lids but did not require further revision. One patient experienced mild helix deformity at the donor site, which did not warrant additional intervention.
In cases of lower lid retraction associated with middle/posterior lamellar shortening, utilizing an autologous auricular scapha cartilage spacer graft offers notable benefits. These advantages comprise straightforward harvesting with minimal donor site complications, stability without experiencing shrinkage, a softer texture in comparison to posterior cartilage, a concave shape that facilitates proper fitting on the globe, and its autologous nature.
评估利用自体耳甲软骨（位于耳轮和对耳轮前表面沟之间）进行下眼睑退缩手术的疗效，并介绍一组患者的手术结果。
回顾性分析 21 例接受下眼睑退缩手术的患者的病历，这些患者均接受了耳甲软骨手术。这些患者的眼睑退缩症状已经存在了较长时间（6 个月至 20 年），下穹隆巩膜暴露度为 1 毫米或以上，原因是先前的下眼睑眼睑成形术、面瘫或正常解剖变异。手术干预包括外侧眦切开术、眦松解术、切开跗骨结膜-下眼睑退缩肌、下眼睑退缩肌松解术、软骨移植物缝合至无结膜覆盖的缺损区域，以及所有患者的外侧眦角收紧。
21 例患者的 29 只眼睑均无术中并发症。在平均 11 个月（6-30 个月）的随访期内，96.5%的眼睑下眼睑退缩得到改善。术后睑裂至反射距离测量值（MRD2）与术前相比显著降低（p=0.001;p<0.01）。MRD2-a（瞳孔至下眼睑）和 MRD2-b（外侧角膜缘至下眼睑）的平均改善分别为 1.77±0.80 和 2.04±0.81（p=0.001;p<0.01）。由于外侧眦角松动，4 只眼睑（4/29）需要再次手术，需要进行骨膜瓣矫正。这 4 名患者之前均在其他地方接受过两次或更多次修复。2 只眼睑可见移植物，但不需要进一步修正。1 名患者供体部位出现轻度耳轮畸形，但无需进一步干预。
对于中/后层板缩短引起的下眼睑退缩，采用自体耳甲软骨间隔物移植有显著的益处。这些优点包括：手术操作简单，供体部位并发症少；软骨稳定，无收缩；质地较软，与后软骨相比；形状为凹面，便于在眼球上正确贴合；并且是自体组织。
