Reply Re: "A New Surgical Technique for Postoperative Trachomatous Trichiasis".
Reply Re: "A New Surgical Technique for Postoperative Trachomatous Trichiasis".
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DOI：
10.1097/iop.0000000000002166
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发表时间：
2022-03-01
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
我们要感谢dr。迪亚布和艾伦的贴心评论。他们是正确的，削减跗骨会进一步缩短它。然而，垂直较短的跗骨并非天生不稳定。作为眼科整形外科医生，我们通常会在重建下眼睑时留下较短的跗骨结膜瓣，使上眼睑保持其正常的解剖形状和位置。相反，是眼睑边缘的畸形解剖和没有方形的后睑缘，使得眼睑边缘不稳定。斜面旋转推进手术有助于创造一个新的后睑缘。1 .“前后板解剖平衡伴继发性相对垂直眼睑皮肤冗余”2一般随年龄增长而发生，造成我们经常治疗的明显的皮肤松弛症。皮肤松弛也会引起睫毛下垂。我们同意在沙眼性倒睫（TT）或术后TT （PTT）的情况下，随着眼睑愈合，额外的上睑皮肤可能会导致睑内翻的复发。正是由于这个原因，在眼睑愈合期间，将缝合线置于睫毛上方，以稳定地将睫毛固定在外部旋转的位置。在斜面旋转推进术中，对于上睑皮肤接触睫毛的患者，我们也建议将缝线放置在较高的位置。较高的缝合线从穆勒肌到皮肤，用来固定眼睑的折痕。这和Diab五步手术的最后一步是一样的，闭合皮肤切口，结合上眼睑牵开器的边缘。
We would like to thank Drs. Diab and Allen for their thoughtful comments. They are correct that cutting the tarsus further shortens it. However, a vertically shorter tarsus is not inherently unstable. As oculoplastic surgeons, we routinely leave the tarsus shorter when we create a tarsal-conjunctival flap to reconstruct the lower eyelid, and the upper eyelid maintains its normal anatomic shape and position. Rather, it is the abnormal anatomy at the margin and the absence of a square posterior eyelid margin that makes the eyelid margin unstable. The Bevel-Rotation Advancement procedure procedure helps to create a new posterior eyelid margin. 1The “anatomic balance between the anterior and posterior lamellae with secondary relative vertical eyelid skin redundancy” 2 occurs with aging in general, creating the visually-significant dermatochalasis we frequently treat. Dermatochalasis can also cause eyelash ptosis. We agree that in the setting of trachomatous trichiasis (TT) or post-surgical TT (PTT), extra upper eyelid skin can contribute to the recurrence of the entropion as the eyelid heals. It is for that reason that the sutures are placed above the eyelashes to stably fixate them in an externally rotated position while the eyelid is healing. We also advocate placing a higher suture in those patients where upper eyelid skin is touching the lashes at the time of Bevel-Rotation Advancement procedure. That higher suture is placed from Muller’s muscle to the skin to fixate the eyelid crease. This is the same idea as the last step of the Diab’s five-step procedure where the skin incision is closed, incorporating the edge of the upper lid retractors.