Shindo Jun, Matsumura Nozomi, Nakamura Jutaro, Asano Mizuki, Ohno Tomoko, Mizuki Nobuhisa
Department of Ophthalmology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, 232-8555, Japan.
Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan.
Clin Ophthalmol. 2025 Feb 3;19:349-356. doi: 10.2147/OPTH.S503661. eCollection 2025.
This study aimed to investigate changes in corneal morphology following pediatric lower-lid epiblepharon surgery using a topographic modeling system 5 (TMS-5).
A randomized controlled trial compared two surgical interventions for pediatric epiblepharon: incisional (modified Hotz procedure with lid margin splitting) and nonincisional. Corneal topography analysis using the TMS-5 served as an outcome measure. The study included 89 eyes from 50 children aged 3-12 years (mean age, 7.5 ± 2.4 years) diagnosed with moderate epiblepharon. Patients were randomly assigned to the incisional (45 eyes from 25 patients) or nonincisional (44 eyes from 25 patients) groups. Parameters including surface regularity index (SRI), Standard Deviation of Corneal Power (SDP), Irregular Astigmatism Index (IAI), and corneal astigmatism (CYL) were evaluated. The positive rate of Keratoconus Screening System (Keratoconus Index [KCI] and Keratoconus Severity Index [KSI]) was assessed.
The 6-month postoperative mean changes in corneal astigmatism were -0.34 ± 0.96 D (p = 0.012) and -0.21 ± 0.67 D (p = 0.22) in the incisional and nonincisional groups, respectively. Corneal astigmatism parameters significantly improved following both surgical procedures (p < 0.01). Preoperatively, 14.6% and 28.1% of patients were suspected of keratoconus using KCI and KSI, respectively, with a significantly reduced postoperative suspicion positivity rate (p < 0.01).
Corneal astigmatism significantly improved in the incisional group. Both surgical methods improved the postoperative corneal surface smoothness, corneal refractive power variability, and irregular astigmatism. Patients with epiblepharon were occasionally suspected of keratoconus when assessed with TMS, with a higher frequency indicated by KSI.
本研究旨在使用角膜地形图建模系统5（TMS - 5）调查小儿下睑赘皮手术后角膜形态的变化。
一项随机对照试验比较了两种小儿赘皮手术干预措施：切开手术（改良Hotz手术伴睑缘劈开）和非切开手术。使用TMS - 5进行角膜地形图分析作为结果指标。该研究纳入了50名3至12岁（平均年龄7.5±2.4岁）被诊断为中度赘皮的儿童的89只眼睛。患者被随机分配到切开手术组（25名患者的45只眼睛）或非切开手术组（25名患者的44只眼睛）。评估了包括表面规则性指数（SRI）、角膜屈光力标准差（SDP）、不规则散光指数（IAI）和角膜散光（CYL）等参数。评估圆锥角膜筛查系统（圆锥角膜指数[KCI]和圆锥角膜严重程度指数[KSI]）的阳性率。
切开手术组和非切开手术组术后6个月角膜散光的平均变化分别为-0.34±0.96 D（p = 0.012）和-0.21±0.67 D（p = 0.22）。两种手术方法后角膜散光参数均显著改善（p < 0.01）。术前，分别有14.6%和28.1%的患者使用KCI和KSI被怀疑患有圆锥角膜，术后怀疑阳性率显著降低（p < 0.01）。
切开手术组角膜散光显著改善。两种手术方法均改善了术后角膜表面光滑度、角膜屈光力变异性和不规则散光。使用TMS评估时，赘皮患者偶尔被怀疑患有圆锥角膜，KSI显示的频率更高。
