先天性小眼球小睑裂畸形的矫治VIP免费

【摘要】目的:探讨先天性小眼球小睑裂畸形的矫治方法。方法:对11例11眼先天性小眼球小睑裂畸形行结膜瓣全角膜覆盖、外眦开大、结膜囊成形联合术并进行回顾分析。结果:在11例患者中，9例于术后4wk顺利安装预选好的义眼；2例角膜表面结膜瓣愈合不良，治疗痊愈后于术后6wk安装义眼。随访2～21mo，4例更换较大型号义眼，全部病例均能轻松安装义眼，无睑裂回缩，角膜覆盖完好，安装义眼后无明显刺激症状，外观较术前明显改善。结论:采用结膜瓣全角膜覆盖，外眦开大联合结膜囊成形术治疗先天性小眼球畸形,具有外观满意,创伤小,并发症及痛苦少,治疗费用低廉等优点,是一种值得推广的方法。【关键词】先天性；小眼球；小睑裂；整形TreatmentforthecongenitalmalformationsofsmalleyeballandsmallpalpebralfissureHongZhang,JuanJuanLi,ZhiKunZheng,ZhongKunYangFoundationitem:FoundationSupportedbytheDepartmentofEducationYunnanProvince,China(No.08C0107)DepartmentofOphthalmology,YunnanRedCrossHospital,Kunming650021,YunnanProvince,ChinaAbstractAIM:Toinvestigatethetreatmentofthecongenitalmalformationsofsmalleyeballandsmallpalpebralfissure.METHODS:Eleveneyes(11cases)ofcongenitalmalformationwhoacceptedthesurgicaltreatmentincludingconjunctivalflapcoveringtheentirecornea,outercanthalexpanding,andconjunctivalsacformingwereretrospectiveanalyzed.RESULTS:In11cases,9caseswereabletosuccessfullywearthepreselectedartificialeyesafter4weeks,theconjunctivalflapfailedtohealin2cases,butafter6weeksoftreatment,theyhealedtowearartificialeyes.Duringthefollowupof221months,4caseswerereplacedwithlargermodelsofartificialeyes.Allcasescouldeasilywearartificialeyeswithoutpalpebralfissureretraction,thecornealcoveragewasintact,nokenspeckleirritationwithartificialeyes,andtheappearancewereobviouslyimproved.CONCLUSION:Thesurgicalmethodofcoveringcornea,expandingoutercanthus,andconjunctivalsacforming,hastheadvantagesofsatisfactoryappearance,minortrauma,fewercomplications,lesspainandlowcost,andisworthypromotion.KEYWORDS：congenital；smalleyeball；smallpalpebralfissure；plastic0引言先天性小眼球或幼年眼球萎缩可导致睑裂短小，结膜囊缩窄，眼眶发育不良。成年后才来就诊的患者常因睑裂短小、结膜囊狭窄而无法放置义眼，影响外观的改善。我们自2006年以来对11例患者采用结膜瓣全角膜覆盖、外眦开大、结膜囊成形联合术治疗取得满意效果，现报告如下。1对象和方法1.1对象本组11例11眼，先天性小眼球6例，幼年眼球萎缩5例，均为单眼。其中男7例，女4例；右眼7例，左眼4例；年龄17～26岁。患者睑裂宽度18～21mm；睑裂高度2～4mm；结膜囊狭窄，可见发育不良的角膜；眶区轻度塌陷，小号义眼不能植入。1.2方法术前准备不同大小的义眼片消毒备用。球后麻醉及局部浸润麻醉。手术步骤：(1)结膜瓣全角膜覆盖术：显微镜下沿角膜缘360°剪开球结膜，分离松解结膜筋膜瓣，用角膜刀切除包括角膜缘、浅基质层在内的角膜板层。60可吸收线上下相对间断缝合筋膜瓣，50丝线间断缝合结膜瓣，使结膜筋膜瓣覆盖角膜表面。(2)外眦开大术[1]；(3)结膜囊成形术：于结膜囊狭窄的部位，靠近穹隆处剪开结膜，并于结膜下潜行分离使结膜充分松解，试植入合适大小的义眼，致外观满意。于下方穹隆和外眦部结膜面入针，相应皮肤面出针做两对褥式缝线加深穹隆部。用带孔薄壳替换义眼片置入结膜囊，行睑缘缝合。术眼加压包扎24h，全身抗炎治疗，术后3wk拆睑缘缝线、结膜缝线和穹隆部缝线，结膜囊滴抗生素眼液，术后4wk可装配术中已试戴满意的义眼。2结果在11例患者中，9例于术后4wk顺利安装预选好的义眼；2例角膜表面结膜瓣愈合不良，治疗痊愈后于术后6wk安装义眼。随访2～21mo，4例更换较大型号义眼，全部病例均能轻松安装义眼，无睑裂回缩，角膜覆盖完好，安装义眼后无明显刺激症状，外观较术前明显改善。3讨论先天性小眼球患儿...