摘要:
AIM:To study the effect of different surgeries for vision and postoperative complications in leprosy patients with lagophthalmos.METHODS:A retrospective analysis.Totally 68 leprosy patients (97 eyes) with lagophthalmos were selected who treated with different surgeries during May 2007 to September 2015 in our sanatorium.The surgeries included nylon thread correction surgery, tarsorrhaphy, temporalis transposition surgery.We observed and compared the best corrected visual acuity(BCVA) and the rate of postoperative complications, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus.RESULTS:The effect on BCVA of patients treated with nylon thread correction surgery and tarsorrhaphy:the preoperative and postoperative BCVA was significantly different of the two groups (Z=-4.193,-4.213;P0.05).The postoperative complications:(1) epiphora:there was 91% in patients underwent nylon thread correction surgery, 89% in patients underwent tarsorrhaphy, 59% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=12.198, P0.05).术后并发症:(1)溢泪:尼龙线矫治术占91%,眼睑缝合占89%,颞肌移位术占59%,三者比较差异具有统计学意义(χ2=12.198,P<0.05);(2)泪器损伤:尼龙线矫治术占66%,眼睑缝合术占95%,颞肌移位占41%,三者比较差异具有统计学意义(χ2=22.415,P<0.05);(3)睁眼困难:尼龙线矫治术占56%,眼睑缝合术占55%,颞肌移位术占22%,三者比较差异具有统计学意义(χ2=8.795,P<0.05);(4)术后感染:尼龙线术占84%,眼睑缝合术占3%,颞肌移位占11%,三者比较差异具有统计学意义(χ2=60.858,P<0.05).结论:麻风性兔眼手术矫治虽有一定的临床效果,尤其是颞肌移位术后患者能主动闭眼,其视力、视觉质量无显著变化.提示该手术可预防角膜的暴露性损害.但手术造成的医源性损伤与其他组间患者的视觉质量下降和眼组织损害(溢泪、泪道损伤、内外眦部感染、泪器组织瘢痕化等)应引起足够的重视.