刘兆川 史俊虎 李荣荣 白萍

[摘要]目的：觀察和分析改良型异体巩膜条带悬吊术矫正麻痹性下睑外翻矫正的效果。方法：选取2016年1月-2019年1月在河北省眼科医院诊治的20例（20眼）中、重度麻痹性下睑外翻患者的临床资料。所有患者采用改良异体巩膜条带悬吊术，针对患者下睑外翻程度对下睑内、外层进行个性化治疗，并通过下睑缘角膜映光点距离（MRD2）、巩膜暴露高度和眼睑闭合不全高度对手术效果进行定量评估。结果：术后随访12～36个月。20例患者中，仅2例患者在术后1年仍出现2～3mm眼睑闭合不全，其余患者双眼下睑对称美观、切口瘢痕淡化，且未出现异体巩膜感染和排斥的病例。术前MRD2为（8.06±0.79）mm，术后1年为（5.18±0.59）mm;术前巩膜暴露（2.31±0.85）mm，术后1年巩膜暴露（0.44±0.41）mm;术前眼睑闭合不全（5.14±1.04）mm，术后1年眼睑闭合不全为（1.06±0.82）mm，以上三项指标差异均有统计学意义（t=19.927，P=0.000;t=14.521，P=0.000;t=24.888，P=0.000）。结论：改良型异体巩膜条带悬吊术具有术后效果稳定、复发率低和并发症少的优点，是治疗麻痹性下睑外翻的一种可靠的手术方法。

[关键词]麻痹性下睑外翻;异体巩膜;睑板;巩膜暴露;改良术式

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）05-0001-04

Effect of Modified Allogeneic Sclera Strip Suspension on the Correction of Paralytic Lower Eyelid Ectropion

LIU Zhao-chuan1，SHI Jun-hu2，LI Rong-rong2，BAI Ping2

（1.Eye Center，Beijing Tongren Hospital Affiliated to Capital Medical University，Beijing 100730，China;2.Department of Ophthalmic Plastic and Lacrimal Disease，Hebei Provincial Eye Hospital，Xingtai 054001，Hebei，China）

Abstract： Objective  To observe and evaluate the efficacy of modified allogeneic sclera strip suspension in the treatment of paralytic lower eyelid ectropion. Methods  The clinical records of 20 patients （20 eyes） who were diagnosed and treated for paralytic lower eyelid ectropion between January 2016 and January 2019 at Hebei Provincial Eye Hospital were analyzed. All patients received modified allogeneic sclera strip suspension for the correction of paralytic lower eyelid ectropion and customized surgical strategies were made according to the degree of ectropion. The preoperative and postoperative degree of ectropion was measured， including margin reflex distance 2 （MRD2）， scleral show and lagophthalmos. Results  The patients were followed up for 12 to 36 months. Although residual lagophthalmos of 2-3mm occurred in 2 cases， the other patients achieved symmetrical and aesthetic outcomes with faded incision scars. Besides， there were no cases of allogeneic scleral infection or rejection. The preoperative margin reflex distance 2 （MRD2） was （8.06±0.79）mm， and the postoperative MRD2 was （5.18±0.59）mm. The preoperative scleral show was （2.31±0.85）mm， and the postoperative data was （0.44±0.41）mm. The preoperative lagophthalmos was （5.14±1.04）mm， and the postoperative data was （1.06±0.82）mm. The differences between the preoperative and postoperative data were statistically significant （t=19.927， P=0.000; t=14.521， P=0.000; t=24.888， P=0.000）. Conclusion  Modified allogeneic sclera strip suspension is an effective method for the correction of paralytic lower eyelid ectropion， with good cosmetic appearance， low recurrence rate and few surgical complications.

Key words： paralytic lower eyelid ectropion; allogeneic sclera; tarsal plate; scleral show; modified operation

麻痹性下睑外翻常见于面神经麻痹、Bell麻痹、中枢神经系统肿瘤和麻风病患者，主要表现为眼轮匝肌张力下降、下睑缘外翻和眼睑闭合不全[1]，严重者可导致结膜干燥肥厚、睑球分离、暴露性角膜炎和角膜溃疡等并发症[2-3]。若下睑外翻累及内侧时，可出现下泪小点外翻并导致泪溢[4-5]。目前对于麻痹性下睑外翻的治疗以手术为……