A New Surgical Technique for Postoperative Trachomatous Trichiasis.
A New Surgical Technique for Postoperative Trachomatous Trichiasis.
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DOI：
10.1097/iop.0000000000002055
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发表时间：
2021-11-01
影响因子：
2
通讯作者：
Gower EW
中科院分区：
文献类型：
--
作者：
Merbs SL;Talero SL;Tadesse D;Sisay A;Bayissasse B;Weaver JU;Gower EW
世界卫生组织已将术后倒睫（PTT）的管理确定为消除致盲性沙眼这一公共卫生问题所需的关键剩余重点领域之一。我们开发了斜面旋转推进程序（B-RAP）来治疗需要重复倒睫手术的患者。倒睫手术造成的疤痕会导致眼睑变厚和扭曲，使重复手术更加困难。为了使B-RAP后的眼睑厚度最小化，在睑板上做一个斜面切口，允许睫毛片段的边缘旋转。在斜切口上方的前后板层之间进行剥离并去除瘢痕组织，允许边缘旋转与后板层推进相结合，以治疗伴有PTT和眼睑轮廓异常（ECA）的严重瘢痕眼睑。两位外科医生对30例PTT患者的44只眼睑进行了B-RAP。既往TT手术的数量从2例到4例以上不等。在术后3-6个月访视时，37例眼睑（84%）没有PTT复发。三个眼睑有中央睫毛接触;其余患有复发性PTT的眼睑有鼻睫毛和/或颞睫毛接触。15例眼睑（34%）有ECA，但只有1例严重。B-RAP是考虑到TT术后眼睑解剖结构的改变而开发的。睫毛碎片的变薄和术后疤痕组织的去除提高了外旋后推进和稳定睫毛碎片的能力。B-RAP显示出作为一种改善重复倒睫手术结果的方法的前景。斜面旋转推进术是为重复沙眼倒睫手术而开发的。
The World Health Organization has identified management of post-operative trichiasis (PTT) as one of the key remaining areas of focus needed to eliminate blinding trachoma as a public health problem. We developed the Bevel-Rotation Advancement Procedure (B-RAP) to treat individuals who need repeat trichiasis surgery. Scarring caused by trichiasis surgery can cause the eyelid to become thick and distorted, making repeat surgery more difficult. To minimize eyelid thickness following B-RAP, a beveled incision of the tarsus is made allowing a marginal rotation of the eyelash fragment. Dissection between the anterior and posterior lamellae above the beveled incision and removal of scar tissue allows the marginal rotation to be combined with a posterior lamellar advancement to treat severely scarred eyelids with PTT and eyelid contour abnormalities (ECAs). Two surgeons performed B-RAP on 44 eyelids of 30 patients with PTT. The number of prior TT surgeries ranged from two to more than four. At the 3–6 months post-operative visit, 37 eyelids (84%) had no recurrence of PTT. Three eyelids had central lashes touching; the remaining eyelids with recurrent PTT had nasal and/or temporal lashes touching. Fifteen eyelids (34%) had ECAs, but only one was severe. B-RAP was developed considering the altered eyelid anatomy found in the post-surgical eyelid with TT. Thinning of the eyelash fragment and removal of post-operative scar tissue improves the ability to advance and stabilize the eyelash fragment after external rotation. B-RAP shows promise as a procedure for improving outcomes of repeat trichiasis surgery. The Bevel-Rotation Advancement Procedure was developed for repeat trachomatous trichiasis surgery.