埋线法重睑术后角膜上皮病变的临床研究  

Clinical study of corneal epithelial lesions after buried suture blepharoplasty

作　　者：陆淑婷 韩雪 徐英男 薛劲松 Lu Shuting;Han Xue;Xu Yingnan;Xue Jinsong(Department of Keratology,the Affiliated Eye Hospital of Nanjing Medical University,Nanjing 210029,China;The Fourth Clinical School of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学眼科医院角膜病科,南京210029 [2]南京医科大学第四临床医学院,南京210029

出　　处：《中华眼外伤职业眼病杂志》2023年第9期680-687,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：南京市医学科技发展一般性课题(YKK17273)。

摘　　要：目的 分析埋线法重睑术导致的角膜上皮病变的临床特点.方法 回顾性病例系列研究.纳入南京医科大学眼科医院 2015 年 1 月至 2022 年 9 月埋线法重睑术后引起的角膜上皮病变31 例(31 眼).分析患者的临床特点.结果 患者均单眼发病.临床表现主要为反复出现眼部刺激症状,角膜呈现不同程度的上皮糜烂及增生,其中角膜上皮糜烂 18 例(58.06%);角膜上皮轻度增生12 例(38.71%);角膜上皮重度增生 1 例(3.23%).病程 18.00(11.00,37.00)个月,范围 4~228 个月.角膜上皮糜烂组和角膜上皮增生组病程相比差异有统计学意义[11.00(7.75,18.75)个月 vs 44.00(26.00,59.50)个月,Z=-4.06,P<0.05],两组视力(BCVA,logMAR)相比差异有统计学意义[0.75(0.60,0.80)vs 0.40(0.30,0.60),Z=-2.88,P<0.05].两组病灶面积差异无统计学意义[6.00(3.75,9.00)mm^(2) vs 4.00(3.00,7.00)mm^(2),Z=-0.66,P>0.05].病程与角膜病变性质呈正相关关系(ρ=0.76,P<0.01),病程、角膜病变性质均与视力(BCVA)呈负相关(ρ=-0.74,P<0.01;ρ=-0.55,P<0.01).13 例拆除缝线联合增生病灶切除术后治愈.结论 埋线法重睑术后可能出现缝线暴露,导致角膜上皮不同程度的病变,表现为角膜上皮糜烂或增生等,容易误诊,需要仔细探查上睑结膜和穹隆结膜并拆除缝线,角膜上皮增生需要手术剥除.Objective To analyze the clinical characteristics of corneal epithelial lesions after buried suture blepharoplasty.Methods This was a retrospective case series study.A total of 31 eyes of 31 cases with corneal epithelial lesions caused by buried suture blepharoplasty from Jan.2015 to Sep.2022 in the Affiliated Eye Hospital of Nanjing Medical University were collected.The clinical characteristics of the patients were analyzed.Results All patients had monocular onset.The clinical manifestations were mainly recurrent ocular irritation symptoms.The corneas showed different degrees of epithelial erosion and hyperplasia,including corneal epithelial erosion in 18 cases,accounting for 58.06%;mild corneal epithelial hyperplasia in 12 cases,accounting for 38.71%;and severe corneal epithelial hyperplasia in 1 case,accounting for 3.23%.The course of the disease was 18.00(11.00,37.00)months with a range of 4 to 228 months.There was a statistically significant difference in course of disease between the corneal epithelial erosion group and the corneal epithelial hyperplasia group[11.00(7.75,18.75)months vs 44.00(26.00,59.50)months,Z=-4.06,P<0.05],and the difference in the best corrected visual acuity(BCVA)was statistically significant between the two groups[0.75(0.60,0.80)vs 0.40(0.30,0.60),Z=-2.88,P<0.05],and the difference in lesion area between the two groups was not statistically significant[6.00(3.75,9.00)mm^(2) vs 4.00(3.00,7.00)mm^(2),Z=-0.66,P>0.05].The course of the disease was positively correlated with the nature of the corneal lesion(ρ=0.76,P<0.01),and the course of the disease and the nature of the corneal lesion were negatively correlated with the best corrected visual acuity(BCVA)(ρ=-0.74,P<0.01;ρ=-0.55,P<0.01).Thirteen cases were cured after removal of sutures combined with excision of the hyperplastic lesion.Conclusion Suture exposure may occur after buried suture blepharoplasty,resulting in different degrees of lesions such as corneal epithelial erosion or hyperplasia,which are easily misdiagnosed.Careful

关 键 词：病变 上皮 角膜 缝线 重睑术 方法 缝线 埋入 

分 类 号：R779.6[医药卫生—眼科]