唇黏膜移植修复睑缘缺损术后眼表状况的研究

doi:10.3969/j.issn.1674-8115.2021.02.024

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (2): 273-276.doi: 10.3969/j.issn.1674-8115.2021.02.024

唇黏膜移植修复睑缘缺损术后眼表状况的研究

吴旭昇(), 吴越, 邵春益(), 李瑾()

上海交通大学医学院附属第九人民医院眼科，上海市眼眶病眼肿瘤重点实验室，上海 200011

收稿日期:2020-06-17 出版日期:2021-02-28 发布日期:2021-02-28
作者简介:吴旭昇（1993—），男，住院医师，硕士生；电子信箱：18817865201@163.com。
基金资助:
国家重点研发计划(2018YFC1106100);国家自然科学基金(81870688);上海市自然科学基金(19441900800);上海市浦江人才计划(18PJD025);上海市教育委员会高峰高原学科建设计划(20191914)

Evaluation of ocular surface following lip mucosa graft for palpebral margin defect

Xu-sheng WU(), Yue WU, Chun-yi SHAO(), Jin LI()

Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China

Received:2020-06-17 Online:2021-02-28 Published:2021-02-28
Supported by:
National Key R&D Program of China(2018YFC1106100);National Natural Science Foundation of China(81870688);Natural Science Foundation of Shanghai(19441900800);Shanghai Pujiang Program(18PJD025);Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20191914)

摘要/Abstract

摘要：

目的·分析唇黏膜移植重建睑缘术后的眼表及泪膜状态。方法·选择2017年11月至2019年12月在上海交通大学医学院附属第九人民医院眼科就诊的15例睑缘缺损患者为研究对象。均行唇黏膜移植术重建上睑缘，术后6~8周行眼表综合分析仪检查，包括：泪河高度（tear meniscus height，TMH）、泪膜破裂时间（tear film breakup time，BUT）和泪液分泌试验。术后复查时测量双眼睑裂高度（palpebral fissure height，PFH）和提上睑肌功能（levator function，LF）。术眼相关数据与自身健眼对应数据比较。患者在术后6~8周时填写眼表疾病指数（Ocular Surface Disease Index，OSDI）量表。结果·健眼TMH（0.24±0.07）mm，术眼TMH（0.23±0.11）mm，差异无统计学意义（P=0.316）；健眼BUT（10.75±2.31）s，术眼BUT（7.75±2.05）s，差异无统计学意义（P=0.065）；泪液分泌试验中健眼（10.20±1.96）mm/5 min，患眼（9.33±2.04）mm/5 min，差异无统计学意义（P=0.376）；健眼PFH（10.16±1.18）mm，患眼PFH（10.11±2.11）mm，差异无统计学意义（P=0.761）；健眼LF（9.59±0.93）mm，患眼LF（9.03±1.02）mm，差异无统计学意义（P=0.552）。患者OSDI量表平均得分为26.44±3.88。结论·唇黏膜移植重建睑缘术后6~8周可获得较为满意的泪膜稳定性和双眼对称度；OSDI量表提示患者术后6~8周时可能存在干眼。

关键词: 睑缘缺损, 唇黏膜移植, 睑缘重建, 眼表

Abstract:

Objective·To analyze the condition of ocular surface and tear film after reconstruction of palpebral margin with lip mucosa graft.

Methods·Fifteen patients with palpebral margin defect who were treated in the Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from November 2017 to December 2019 were selected. All patients underwent the lip mucosa graft for palpebral margin reconstruction. A series of ocular surface examination, some ophthalmological physical examination and a questionnaire were prepared for each patient 6?8 weeks after surgery. The ocular surface examination was constituted of tear meniscus height (TMH), tear break-up time (BUT) and Schirmer test. The ophthalmological physical examination included affected palpebral fissure height (PFH) and levator function (LF). Finally, Ocular Surface Disease Index (OSDI) was used as a questionnaire.

Results·There was no significant difference in TMH between fellow eyes and operated eyes [(0.24±0.07) mm vs (0.23±0.11) mm, P=0.316]. There was no significant difference in BUT between fellow eyes and operated eyes [(10.75±2.31) s vs (7.75±2.05) s, P=0.065]. There was no significant difference in the result of Schirmer text between fellow eyes and operated eyes [(10.20±1.96) mm/5 min vs (9.33±2.04) mm/5 min, P=0.376]. There was no significant difference in PFH between fellow eyes and operated eyes [(10.16±1.18) mm vs (10.11±2.11) mm, P=0.761]. There was no significant difference in LF between fellow eyes and operated eyes [(9.59±0.93) mm vs (9.03±1.02) mm, P=0.552]. The score of OSDI was 26.44±3.88 in average.

Conclusion·The lip mucosa graft for treating palpebral margin defects gives a satisfactory result in tear film stability and binocular symmetry. Patients may have dry eyes according to the score of OSDI 6?8 weeks after surgery.

Key words: palpebral margin defect, lip mucosa graft, palpebral margin reconstruction, ocular surface

中图分类号:

R777.1

吴旭昇, 吴越, 邵春益, 李瑾. 唇黏膜移植修复睑缘缺损术后眼表状况的研究[J]. 上海交通大学学报(医学版), 2021, 41(2): 273-276.

Xu-sheng WU, Yue WU, Chun-yi SHAO, Jin LI. Evaluation of ocular surface following lip mucosa graft for palpebral margin defect[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(2): 273-276.

图/表 3

参考文献 26

1	Holbach LM. Diseases of the eyelid-conjunctival complex and corneal complications of lid disease[J]. Curr Opin Ophthalmol, 1995, 6(4): 39-43.
2	Kompella VB, Sangwan VS, Bansal AK, et al. Ophthalmic complications and management of Stevens-Johnson syndrome at a tertiary eye care centre in south India[J]. Indian J Ophthalmol, 2002, 50(4): 283-286.
3	Cher I. Blink-related microtrauma: when the ocular surface harms itself[J]. Clin Exp Ophthalmol, 2003, 31(3): 183-190.
4	Pullum K, Buckley R. Therapeutic and ocular surface indications for scleral contact lenses[J]. Ocular Surf, 2007, 5(1): 40-49.
5	Tougeron-Brousseau B, Delcampe A, Gueudry J, et al. Vision-related function after scleral lens fitting in ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. Am J Ophthalmol, 2009, 148(6): 852-859.e2.
6	Sindt CW, Longmuir RA. Contact lens strategies for the patient with dry eye[J]. Ocular Surf, 2007, 5(4): 294-307.
7	Kheirkhah A, Blanco G, Casas V, et al. Surgical strategies for fornix reconstruction based on symblepharon severity[J]. Am J Ophthalmol, 2008, 146(2): 266-275.e4.
8	Siegel RJ. Palatal grafts for eyelid reconstruction[J]. Plast Reconstr Surg, 1985, 76(3): 411-414.
9	Leone CR. Mucous membrane grafting for cicatricial entropion[J]. Ophthalmic Surg, 1974, 5(2): 24-28.
10	McCord CD, Chen WP. Tarsal polishing and mucous membrane grafting for cicatricial entropion, trichiasis and epidermalization[J]. Ophthalmic Surg, 1983, 14(12): 1021-1025.
11	Whitehouse GM, Francis IC. Eyelid reconstruction using a monopedicle flap and buccal mucosa: report of 15 cases[J]. Aust N Z J Ophthalmol, 1988, 16(4): 295-301.
12	Shore JW, Foster CS, Westfall CT, et al. Results of buccal mucosal grafting for patients with medically controlled ocular cicatricial pemphigoid[J]. Ophthalmology, 1992, 99(3): 383-395.
13	Karesh JW, Putterman AM. Reconstruction of the partially contracted ocular socket or fornix[J]. Arch Ophthalmol, 1988, 106(4): 552-556.
14	Klein M, Menneking H, Bier J. Reconstruction of the contracted ocular socket with free full-thickness mucosa graft[J]. Int J Oral Maxillofac Surg, 2000, 29(2): 96-98.
15	Miyamoto J, Nakajima T, Nagasao T, et al. Full-thickness reconstruction of the eyelid with rotation flap based on orbicularis oculi muscle and palatal mucosal graft: long-term results in 12 cases[J]. J Plast Reconstr Aesthetic Surg, 2009, 62(11): 1389-1394.
16	Larsen SD, Heegaard S, Toft PB. Histological and clinical evaluation of the hard palate mucous membrane graft for treatment of lower eyelid retraction[J]. Acta Ophthalmol, 2017, 95(3): 295-298.
17	Fu Y, Liu J, Tseng SC. Oral mucosal graft to correct lid margin pathologic features in cicatricial ocular surface diseases[J]. Am J Ophthalmol, 2011, 152(4): 600-608. e1.
18	Mizuno Y, Yamada M, Miyake Y, et al. Association between clinical diagnostic tests and health-related quality of life surveys in patients with dry eye syndrome[J]. Jpn J Ophthalmol, 2010, 54(4): 259-265.
19	Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the ocular surface disease index[J]. Arch Ophthalmol, 2000, 118(5): 615-621.
20	McVeigh KA, Caesar R. Upper eyelid reconstruction using a blepharoplasty flap[J]. Ophthalmic Plast Reconstr Surg, 2017, 33(2): 147-149.
21	Jordan DR, Tse DT, Anderson RL, et al. Irradiated homologous tarsal plate banking. Part II. Human data [J]. Ophthalmic Plast Reconstr Surg, 1990, 6(3): 168-176.
22	Carroll RP. Entropion following the cutler-beard procedure[J]. Ophthalmology, 1983, 90(9): 1052-1055.
23	Yaqub A, Leatherbarrow B. The use of autogenous auricular cartilage in the management of upper eyelid entropion[J]. Eye, 1997, 11(6): 801-805.
24	Scuderi N, Ribuffo D, Chiummariello S. Total and subtotal upper eyelid reconstruction with the nasal chondromucosal flap: a 10-year experience[J]. Plast Reconstr Surg, 2005, 115(5): 1259-1265.
25	Holloman EL, Carter KD. Modification of the cutler-beard procedure using donor Achilles tendon for upper eyelid reconstruction[J]. Ophthalmic Plast Reconstr Surg, 2005, 21(4): 267-270.
26	Vaca EE, Surek C, Klosowiak J, et al. Neurotized free platysma flap for functional eyelid reconstruction: a cadaveric study of anatomical feasibility[J]. Plast Reconstr Surg, 2020, 145(4): 1049-1057.

No	Gender	Age/year	Eye	Ratio of defect to palpebral fissure length	Cause of defect
1	Male	22	Right	2/3	Trauma
2	Male	51	Right	1/2	After eyelid tumor resection
3	Male	47	Left	1/2	After eyelid tumor resection
4	Female	41	Left	2/3	Trauma
5	Male	46	Left	1/2	After eyelid tumor resection
6	Female	39	Right	4/5	Chemical burn
7	Male	44	Left	2/3	Chemical burn
8	Female	37	Left	1/2	Chemical burn
9	Male	53	Right	4/5	Chemical burn
10	Female	72	Right	4/5	After eyelid tumor resection
11	Female	67	Left	1/2	After eyelid tumor resection
12	Female	46	Right	1/2	After eyelid tumor resection
13	Male	19	Left	2/3	Trauma
14	Male	51	Left	1/2	After eyelid tumor resection
15	Female	66	Left	1/2	Chemical burn

No	Gender	Age/year	Eye	Ratio of defect to palpebral fissure length	Cause of defect
1	Male	22	Right	2/3	Trauma
2	Male	51	Right	1/2	After eyelid tumor resection
3	Male	47	Left	1/2	After eyelid tumor resection
4	Female	41	Left	2/3	Trauma
5	Male	46	Left	1/2	After eyelid tumor resection
6	Female	39	Right	4/5	Chemical burn
7	Male	44	Left	2/3	Chemical burn
8	Female	37	Left	1/2	Chemical burn
9	Male	53	Right	4/5	Chemical burn
10	Female	72	Right	4/5	After eyelid tumor resection
11	Female	67	Left	1/2	After eyelid tumor resection
12	Female	46	Right	1/2	After eyelid tumor resection
13	Male	19	Left	2/3	Trauma
14	Male	51	Left	1/2	After eyelid tumor resection
15	Female	66	Left	1/2	Chemical burn

[1]	阿婷曦, 邵春益, 傅瑶. 调节性T细胞在眼表疾病中作用的研究进展[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1145-1150.
[2]	陈良波，何芳邻，严晨曦，陆琳娜，范先群,傅瑶 . 改良超声生物显微镜检查法在眼表热化学烧伤后中度及重度睑球粘连诊疗中的应用[J]. 上海交通大学学报（医学版）, 2017, 37(11): 1496-.
[3]	沈婷, 张琳. 新型角膜地形图仪观察泪膜稳定性及其与眼表角膜温度的关系[J]. , 2011, 31(8): 1086-.
[4]	李瑾, 林明, 傅瑶, 等. 羊膜和唇黏膜联合自体角膜缘移植重建眼表热化学烧伤后结膜穹窿的疗效观察[J]. , 2011, 31(8): 1061-.

唇黏膜移植修复睑缘缺损术后眼表状况的研究

Evaluation of ocular surface following lip mucosa graft for palpebral margin defect

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 26

相关文章 4

编辑推荐

Metrics

Item	Fellow eye	Operated eye	P value
TMH/mm	0.24±0.07	0.23±0.11	0.316
BUT/s	10.75±2.31	7.75±2.05	0.065
Schirmer test/[mm·(5 min)^-1]	10.20±1.96	9.33±2.04	0.376
PFH/mm	10.16±1.18	10.11±2.11	0.761
LF/mm	9.59±0.93	9.03±1.02	0.552