Lai Wei-Yu, Demer Joseph L
From the Stein Eye Institute and Department of Ophthalmology, University of California (W.-Y.L., J.L.D.), Los Angeles, California, USA; Department of Ophthalmology, Kaohsiung Veterans General Hospital (W.-Y.L.), Kaohsiung, Taiwan.
From the Stein Eye Institute and Department of Ophthalmology, University of California (W.-Y.L., J.L.D.), Los Angeles, California, USA; Department of Neurology, University of California (J.L.D.), Los Angeles, California, USA; Bioengineering Department, University of California (J.L.D.), Los Angeles, California, USA; Neuroscience Interdepartmental Program, University of California (J.L.D.), Los Angeles, California, USA.
Am J Ophthalmol. 2025 Jan;269:466-470. doi: 10.1016/j.ajo.2024.09.030. Epub 2024 Oct 10.
The lower eyelid is anatomically coupled to the inferior rectus (IR) muscle, so that IR recession alone causes lower lid retraction often symptomatic due to corneal exposure. Although procedures within the conjunctival incision reduce retraction slightly, cutaneous lower eyelid retractor release (CLERR) eliminates this problem.
Retrospective comparative interventional case series.
We reviewed 89 consecutive IR recessions performed by one surgeon between September 2019 and May 2024, of which 71 included CLERR performed after local anesthetic infiltration in 2-3 minutes by dissection of the retractors from the inferior margin of the tarsus via skin incision over the lateral orbital rim, using scissors blades visualized through the intact inferior tarsal conjunctiva. Inferior scleral show was measured an average of 116 days postoperatively.
Although mean IR recession was greater at 4.6 ± 1.8 mm (standard deviation, range 2-8 mm) with CLERR than 3.2 ± 1.2 mm (range 2-6 mm) without it (P = .003), inferior scleral show averaged less with CLERR at 0.2 ± 0.9 mm than 0.7 ± 1.0 mm without it (P = .043). The procedure was also effective in thyroid ophthalmopathy. Lower lid ecchymosis occurred in 22 (31%) cases with CLERR, but resolved within one week without patient complaints. The skin incision healed without visible scar in 5-7 days. There was one complication of severing an IR hangback suture that was repaired during suture adjustment.
CONCLUSION/RELEVANCE: CLERR is a quick and simple procedure that virtually eliminates lower eyelid retraction following IR recession of any amount, avoiding inferior scleral show and new dry eye symptoms without additional conjunctival dissection. It is a quick oculoplastic procedure readily performed by any strabismus surgeon.
下眼睑在解剖结构上与下直肌相连，因此仅下直肌后徙就常常会因角膜暴露导致下睑退缩并出现症状。尽管结膜切口内的手术可轻微减轻退缩，但皮肤下睑牵开器松解术（CLERR）可消除此问题。
回顾性比较干预性病例系列。
我们回顾了一位外科医生在2019年9月至2024年5月期间连续进行的89例下直肌后徙手术，其中71例包括CLERR，即在局部麻醉浸润2 - 3分钟后，通过外侧眶缘上方的皮肤切口，经完整的下睑结膜观察到的剪刀刀片，从睑板下缘分离牵开器。术后平均116天测量下巩膜显露情况。
尽管采用CLERR时平均下直肌后徙量为4.6±1.8毫米（标准差，范围2 - 8毫米），大于未采用CLERR时的3.2±1.2毫米（范围2 - 6毫米）（P = 0.003），但采用CLERR时下巩膜显露平均为0.2±0.9毫米，小于未采用时的0.7±1.0毫米（P = 0.043）。该手术在甲状腺眼病中也有效。采用CLERR的22例（31%）出现下睑瘀斑，但在一周内消退，患者无不适主诉。皮肤切口在5 - 7天愈合，无可见瘢痕。有1例在缝线调整期间修复了切断的下直肌回退缝线的并发症。
结论/意义：CLERR是一种快速简单的手术，几乎可消除任何量下直肌后徙后的下睑退缩，避免下巩膜显露和新的干眼症状，无需额外的结膜分离。这是一种任何斜视外科医生都能轻松进行的快速眼整形手术。
