背景:上睑下垂在老年人中很常见。收紧眼睑推迟手术可能会增加眼睑和眼表之间的摩擦,但是这一假设尚未得到研究的证实。作者探讨了内卷性上睑下垂手术与摩擦相关疾病的关系,即结膜松弛症,眼睑刮水器上皮病变,和上缘角膜结膜炎。
方法:我们进行了一项前瞻性研究,纳入了31名患者,这些患者因内卷性上睑下垂而接受了提上凸。术前和术后6周,作者评估了一系列结果指标,包括边缘反射距离-1,2,泪膜破裂时间,浅表点状角膜病变,下结膜松弛症,上眼睑刮水器上皮病变,和上缘角膜结膜炎。
结果:术前18只眼,术后20只眼发现结膜松弛症。术前在2只眼中检测到眼睑刮水器上皮病变,术后在无眼中检测到。术前2眼和术后1眼检出上缘角膜结膜炎。从术前到术后评估,结膜松弛症恶化11眼(17.2%),并且没有眼睛恶化的眼睑刮水器上皮病或上缘角膜结膜炎。与未改变组相比,结膜松弛症加重组浅表点状角膜病变明显恶化(0.72vs.0.12,P=0.0222)。6例结膜松弛症和浅表点状角膜病变均恶化,浅表点状角膜病变均位于角膜下方。
结论:结膜松弛症可以在上睑下垂手术后恶化,可能导致下浅表点状角膜病变的增加。当进行内卷性上睑下垂手术时,外科医生应该注意摩擦相关疾病的潜在影响,尤其是结膜松弛症。
BACKGROUND: Involutional blepharoptosis is common among elderly people. The tightening of eyelids postptosis surgery could potentially increase friction between the eyelid and the ocular surface, but this hypothesis has not yet been substantiated by research. The authors explored the relationship between involutional blepharoptosis surgery and friction-related diseases, namely conjunctivochalasis, lid wiper epitheliopathy, and superior limbic
keratoconjunctivitis.
METHODS: We conducted a prospective study involving 31 patients who underwent levator advancement for involutional blepharoptosis. Both preoperatively and 6 weeks postoperatively, the authors assessed a range of outcome measures, including margin reflex distance-1, 2, tear film break-up time, superficial punctate keratopathy, inferior conjunctivochalasis, upper lid wiper epitheliopathy, and superior limbic
keratoconjunctivitis.
RESULTS: Conjunctivochalasis was detected in 18 eyes preoperatively and 20 eyes postoperatively. Lid wiper epitheliopathy was detected in 2 eyes preoperatively and in no eyes postoperatively. Superior limbic
keratoconjunctivitis was detected in 2 eyes preoperatively and 1 eye postoperatively. From preoperative to postoperative assessments, conjunctivochalasis worsened in 11 eyes (17.2%), and there were no eyes with worsening lid wiper epitheliopathy or superior limbic
keratoconjunctivitis. There was a significant worsening of superficial punctate keratopathy in the group with exacerbated conjunctivochalasis compared with the unchanged group (0.72 vs. 0.12, P =0.0222). The superficial petechial keratopathy in the 6 cases in which there was worsening of both conjunctivochalasis and superficial petechial keratopathy were all located inferiorly in the cornea.
CONCLUSIONS: Conjunctivochalasis can worsen following ptosis surgery, potentially leading to an increase in inferior superficial punctate keratopathy. When performing involutional blepharoptosis surgery, surgeons should be mindful of the potential implications of friction-related diseases, particularly conjunctivochalasis.