Olver J M, Rose G E, Khaw P T, Collin J R
Moorfields Eye Hospital, London.
Br J Ophthalmol. 1998 Feb;82(2):174-80. doi: 10.1136/bjo.82.2.174.
BACKGROUND/AIMS: Lower eyelid retraction in thyroid eye disease contributes to ocular discomfort and an unsightly appearance, especially if asymmetrical. The use of donor scleral grafts is effective in lengthening the lower eyelids but carries a risk of virus transmission. Other techniques, including those which do not use grafts, need to be compared with scleral grafts. Recurrent retraction is a recognised complication of thyroid eyelid surgery; therefore, the authors investigated the use of antimetabolites to reduce postoperative fibrosis.
In this prospective randomised controlled trial of 25 patients (35 eyelids), the use of donor sclera in 20 lower eyelids (13 patients) was compared with partial tenotomy of the anterior part of the lower eyelid retractors (ALER) with adjuvant peroperative antimetabolite in 15 lower eyelids (12 patients). A 5 minute peroperative application of either 5-fluorouracil (25 mg/ml) in nine lower eyelids (eight patients) or mitomycin C (0.2 mg/ml) in six lower eyelids (four patients) was used to focally inhibit fibroblasts. Follow up ranged from 3 to 18 months (mean 7.8).
One month after surgery the results of both groups were similar. However, at 3 months after surgery the results of scleral grafting were better than tenotomy with antimetabolites: 3/12 patients (25%) treated with tenotomy and adjuvant antimetabolite required subsequent surgery using grafts for correction of recurrent retraction. There were no significant complications associated with the use of antimetabolites in the eyelid in the doses used in this study.
This randomised prospective trial shows that donor scleral grafts were more effective in the long term than partial tenotomy with adjuvant antimetabolite in the correction of lower eyelid retraction associated with thyroid eye disease. The use of peroperative antimetabolites in the lower eyelid was safe.
背景/目的：甲状腺眼病导致的下睑退缩会引起眼部不适且外观不佳，尤其是出现不对称时。使用供体巩膜移植片可有效延长下睑，但存在病毒传播风险。其他技术，包括那些不使用移植片的技术，需要与巩膜移植片进行比较。复发性退缩是甲状腺眼睑手术公认的并发症；因此，作者研究了使用抗代谢药物来减少术后纤维化。
在这项针对25例患者（35只眼睑）的前瞻性随机对照试验中，将20只下睑（13例患者）使用供体巩膜与15只下睑（12例患者）行下睑缩肌前部部分腱切断术并辅助术中抗代谢药物进行比较。对9只下睑（8例患者）术中应用5分钟的5-氟尿嘧啶（25mg/ml）或6只下睑（4例患者）术中应用丝裂霉素C（0.2mg/ml）来局部抑制成纤维细胞。随访时间为3至18个月（平均7.8个月）。
术后1个月两组结果相似。然而，术后3个月时，巩膜移植的效果优于腱切断术联合抗代谢药物：12例行腱切断术并辅助抗代谢药物治疗的患者中有3例（25%）需要后续使用移植片手术来矫正复发性退缩。本研究中使用的剂量的抗代谢药物在眼睑应用中未出现明显并发症。
这项随机前瞻性试验表明，在矫正与甲状腺眼病相关的下睑退缩方面，供体巩膜移植片长期来看比部分腱切断术联合辅助抗代谢药物更有效。在下睑术中使用抗代谢药物是安全的。
