van den Bosch W A, Rosman M, Stijnen T
Department of Oculoplastic Surgery, Rotterdam Eye Hospital, The Netherlands.
Ophthalmic Surg Lasers. 1998 Jul;29(7):581-6.
To evaluate the effect of adding horizontal eyelid tightening and the removal of orbital fat to reinsertion of the lower eyelid retractors to correct involutional entropion.
During 6 consecutive years, 266 cases (229 patients) were treated. Of these, 240 cases (207 patients) showed horizontal laxity, in which reinsertion of the lower eyelid retractors was combined with lower eyelid tightening in the lateral canthal angle. In 60 of these cases (47 patients), prolapsing orbital fat was removed during the operation. In 26 cases (22 patients), no horizontal laxity was found. Their treatment consisted of reinserting the lower eyelid retractors without eyelid tightening. Follow-up of 28 weeks postoperatively was available in all cases. In 213 cases (178 patients), follow-up of 5 months or longer (range 5 to 80 months, average 42 months) was available.
The most common complication of surgery was persistent ectropion, which occurred in 12 cases (5.6%). It occurred significantly more often after reinsertion without horizontal eyelid tightening than after combined reinsertion and horizontal tightening (P = .04). Adding the excision of orbital fat to the latter procedure did not significantly influence the results. Transient ectropion also occurred significantly more often after retractor reinsertion alone than after combined retractor reinsertion and horizontal tightening (P = .01). The entropion recurred in 9 cases (3.3%), 5 of which within 24 months (2.4%). The authors found no difference in recurrence rate between the three groups. A disadvantage of eyelid tightening is tenderness, which was reported by 42 (29%) of the patients. In 9 patients this had persisted longer than 4 months.
Horizontal eyelid laxity is common in involutional entropion. Tightening of the lower eyelid in the lateral canthus, added to reinsertion of the lower eyelid retractors, significantly lowers the incidence of surgical overcorrection, but has no effect on the recurrence rate. A disadvantage of eyelid tightening in the lateral canthus is that it may lead to mostly transient eyelid tenderness.
评估在重新植入下睑缩肌以矫正退行性睑内翻时增加水平睑收紧和去除眶脂肪的效果。
连续6年共治疗266例（229名患者）。其中，240例（207名患者）存在水平松弛，在下睑缩肌重新植入的同时，在外眦角进行下睑收紧。在这些病例中，60例（47名患者）在手术过程中去除了脱垂的眶脂肪。26例（22名患者）未发现水平松弛，其治疗方法是在不进行睑收紧的情况下重新植入下睑缩肌。所有病例均有术后28周的随访数据。213例（178名患者）有5个月或更长时间（范围5至80个月，平均42个月）的随访数据。
手术最常见的并发症是持续性睑外翻，共12例（5.6%）。单纯重新植入而未进行水平睑收紧后发生持续性睑外翻的频率显著高于重新植入并水平收紧联合手术（P = 0.04）。在后者手术中增加眶脂肪切除术对结果无显著影响。单纯缩肌重新植入后发生暂时性睑外翻的频率也显著高于缩肌重新植入与水平收紧联合手术（P = 0.01）。睑内翻复发9例（3.3%），其中5例在24个月内复发（2.4%）。作者发现三组之间的复发率无差异。睑收紧的一个缺点是压痛，42例（29%）患者报告有此症状。9例患者的压痛持续时间超过4个月。
水平睑松弛在退行性睑内翻中很常见。在外眦角收紧下睑并联合重新植入下睑缩肌，可显著降低手术过度矫正的发生率，但对复发率无影响。外眦角睑收紧的一个缺点是可能导致大多为暂时性的睑压痛。
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