Surgical strategies for fornix reconstruction based on symblepharon severity
Surgical strategies for fornix reconstruction based on symblepharon severity
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DOI：
10.1016/j.ajo.2008.03.028
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发表时间：
2008-08-01
影响因子：
4.2
通讯作者：
Tseng, Scheffer C. G.
中科院分区：
文献类型：
--
作者：
Kheirkhah, Ahmad;Blanco, Gabriela;Tseng, Scheffer C. G.
目的：探讨穹隆成形术治疗睑球粘连的手术方法。设计：回顾性、对照、干预性病例分析。方法：对61例(61眼)睑粘连患者分别采用缝线(n=34)、纤维蛋白胶(n=27)、丝裂霉素C(n=47)或不加丝裂霉素C(n=14)或联合移植(n=4)或联合移植(n=4)进行穹隆成形术。结果：随访25+/-10.8个月，首次手术成功52只眼(85.2%)，失败9只眼(14.8%)，再次手术成功率提高到59只眼(96.7%)。在第一次尝试中，仅AMT一次就取得了92.8%的I级眼和100%的11级眼的总体成功率。在I级、11级和III/IV级中，附加锚定缝线成功率分别为100%、70%和71.4%。在III/IV级眼中，附加口腔粘膜或自体结膜移植的成功率为100%。手术完全成功与粘连程度较低或术中使用丝裂霉素C呈正相关，而与年龄较小、斜角受累或使用锚定缝线呈负相关。术前结膜炎症减轻(n=40)，视力提高(n=14)，眼球运动改善(n=18)，眼睑闭合改善(n=3)，可配戴隐形眼镜(n=10)。结论：根据眼球粘连的严重程度，选择性地应用瘢痕松解术和AMT、术中应用MMC、锚定缝线和口腔粘膜或结膜移植均可获得成功。
PURPOSE: To identify surgical strategies of fornix reconstruction for symblepharon graded according to the length from the limbus to the lid margin, to the width, and to associated inflammation.DESIGN: Retrospective, comparative, interventional case series.METHODS: In 61 eyes with symblepharon, cicatrix lysis and amniotic membrane transplantation (AMT) were performed with sutures (n = 34) or fibrin glue (n = 27) together with (n = 47) or without (n = 14) intraoperative mitomycin C (MMC), plus fornix reconstruction using anchoring sutures without (n = 30) or with (n = 7) oral mucosal graft or with conjunctival autograft (n = 4). Overall, success was defined as an outcome of complete success (restoration of an anatomically deep fornix) or partial success (focal recurrence of scar), and failure was defined as the return of symblepharon.RESULTS: For a follow,up of 25 +/- 10.8 months, the overall success was achieved by the first attempt in 52 eyes (85.2%) and failure resulted in nine eyes (14.8%); however, the success rate improved to 59 eyes (96.7%) with additional attempts. At the first attempt, AMT alone achieved overall successes in 92.8% of grade I eyes and in 100% of grade 11 eyes. Additional anchoring sutures achieved successes in 100% of grade I eyes, 70% of grade 11 eyes, and 71.4% of grade III/IV eyes. Additional oral mucosa or conjunctival autograft achieved successes in 100% of grade III/IV eyes. The complete success was correlated positively with lower grades of symblepharon or intraoperative use of MMC, but negatively correlated with younger ages, canthal involvement, or use of anchoring sutures. Anatomic improvement was accompanied by reduction of preoperative conjunctival inflammation (n = 40), improved visual acuity (n = 14), improved ocular motility (n = 18), improved eyelid closure (n = 3), and feasibility of contact lens wear (n = 10).CONCLUSIONS: Successful outcome can be achieved by selectively deploying cicatrix lysis and AMT, intraoper, ative MMC, anchoring sutures, and oral mucosal or conjunctival autograft based on the severity of pathogenic symblepharon.