Elder M J, Collin R
Moorfields Eye Hospital, London, UK.
Eye (Lond). 1996;10 ( Pt 4):439-42. doi: 10.1038/eye.1996.96.
Trichiasis in ocular cicatricial pemphigoid (OCP) is usually due to cicatricial entropion and is a major cause of ocular morbidity. Unfortunately in this disease, direct surgery on the conjunctiva often results in marked inflammation and cicatrisation. This paper assessed a procedure that corrects cicatricial entropion of the upper lid while avoiding surgery to the conjunctiva.
A grey line upper lid split and a vertical anterior lamellar repositioning was performed on 16 lids of 11 patients with OCP.
Anatomical success was achieved in 72% of lids at 1 year and 61% had complete success with no lashes touching the globe. These outcomes were maintained up to 4 years. There were no perioperative complications. Two patients post-operatively developed severe conjunctival inflammation that required systemic immunosuppression. The causes of failure were primary surgical failure (n = 2), progression of cicatrisation secondary to surgically induced inflammation (n = 1), development of misdirected lashes (n = 1) and late recurrence at 7 months (n = 1). One patient developed peaking of the eyelid.
This procedure has a good long-term outcome with minimal complications. Activation of severe conjunctival inflammation occurred in 13% of cases and this must be considered pre- and post-operatively.
眼部瘢痕性类天疱疮（OCP）中的倒睫通常由瘢痕性睑内翻引起，是眼部发病的主要原因。遗憾的是，在这种疾病中，直接对结膜进行手术往往会导致明显的炎症和瘢痕形成。本文评估了一种在避免结膜手术的同时矫正上睑瘢痕性睑内翻的手术方法。
对11例OCP患者的16只眼睑进行了灰线劈开上睑及垂直前层复位术。
1年后72%的眼睑获得解剖学成功，61%完全成功，睫毛未触及眼球。这些结果维持了4年。无围手术期并发症。2例患者术后出现严重的结膜炎症，需要全身免疫抑制治疗。失败原因包括原发性手术失败（n = 2）、手术引起的炎症继发瘢痕形成进展（n = 1）、睫毛方向异常（n = 1）以及7个月时的晚期复发（n = 1）。1例患者出现眼睑尖峰。
该手术方法长期效果良好，并发症极少。13%的病例出现严重结膜炎症激活，术前和术后均必须考虑这一点。
