퇴행성 아래눈꺼풀속말림의 주요 원인을 동시 교정하는 복합수술법의 치료 효과분석

양성원(Sung Won Yang),박진환(Jin Hwan Park),이준식(Jun Sik Lee),이화(Hwa Lee),백세현(Se Hyun Baek) 대한안과학회 2016 대한안과학회지 Vol.57 No.3

목적: 퇴행성 아래눈꺼풀속말림 발생의 3가지 주요 원인을 동시 교정하는 아래눈꺼풀당김기재부착, 가쪽눈꺼풀판띠고정 및 앞층판절제 복합수술의 장기 임상 치료 효과에 대해 알아보았다. 대상과 방법: 2004년 4월부터 2014년 2월까지 고려대학교 구로병원, 천안충무병원에서 아래눈꺼풀의 수직이완, 수평이완, 안와사이막앞 눈둘레근의 상방이동이 동반된 퇴행성 아래눈꺼풀속말림 환자를 대상으로 가쪽 눈구석 인대 이완과 앞층판 여분을 측정하였다. 두 검사의 측정치를 참고하여 복합수술을 동시 시행 받은 환자 중 최소 추적기간이 12개월 이상인 80명 85안을 대상으로 의무기록을 후향적으로 조사하였다. 결과: 퇴행성 아래눈꺼풀속말림 환자 총 80명 85안이 포함되었으며, 평균 연령은 71세, 남성은 35명, 여성은 45명이었고 평균 추적관찰 기간은 26.5개월이었다. 가쪽 눈구석 인대 이완 검사 결과 52안(61.2%)에서 grade II, 33안(38.8%)에서 grade III였고 앞층판 여분정도는 17안(20%)에서 grade I, 57안(67.1%)에서 grade II, 11안(12.9%) grade III였다. 85안 중 84안(98.8%)에서 성공하였으며, 1안(1.2%)에서 재발하였다. 수술 후 외안각 변형이 2안(2.4%)에서 발생하여 재수술을 통해 교정해 주었다. 결론: 최대 3년간의 경과관찰 기간에서 98.8%의 높은 성공률과 0%의 과교정을 보여 아래눈꺼풀당김기재부착술, 가쪽눈꺼풀판띠고정술 및 앞층판절제술은 퇴행성 아래눈꺼풀속말림 치료에 매우 효과적이고 안전한 방법으로 생각된다. Purpose: To evaluate the long-term effectiveness of inferior retractor tightening combined with lateral tarsal strip surgery and anterior lamellar resection for simultaneously correcting the 3 main causes of involutional entropion. Methods: In this retrospective study we reviewed 80 patients diagnosed with involutional entropion between April 2004 and February 2014 at the Korea University Guro Hospital and Cheonan Chungmu Hospital. The patients were evaluated for the 3 major causes of involutional entropion and were confirmed to have all components. Lateral canthal tendon laxity test and anterior lamellar redundancy test were performed to grade the involutional entropion patients. The patients received inferior retractor tightening, lateral tarsal strip operation and anterior lamellar resection procedure simultaneously. Results: Eighty involutional entropion patients were included in the present study. The patients consisted of 35 males and 45 females with an average age of 71.1 ± 9.3 years. In the lateral canthal tendon laxity test, 52 (61.2%) eyes were grade II, 33 (38.8%) eyes were grade III. In the anterior lamellar redundancy test, 17 (20%) eyes were grade I, 57 (67.1%) eyes were grade II and; 11 (12.9%) eyes were grade III. Among the 80 patients, 85 eyelids received combined surgery, 84 had successful outcomes and 1 case recurred at 5 months following the primary surgery with an average follow up of 26.5 ± 4.6 months. Lateral canthal deformity was observed in 2 eyelids which were corrected successfully. Conclusions: Simultaneous correction of the 3 main causes of involutional entropion through inferior retractor tightening, lateral tarsal strip surgery and anterior lamellar resection procedure is effective in correcting involutional entropion and safe in avoiding overcorrection.

자가 주상와연골 (Autogenous scapha cartilage) 이식을 이용한 하안검 내반증의 교정

임 풍,염원석,이석기,한기택 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

The lower eyelid entropion is characterized by a turning inward of the eyelid margin. Ocular inflammation and tearing may result from lashes or keratinized epithelium. Moreover inversed lower eyelids are considered one of the cosmetic defects. To correct an entropion surgically, the procedure should be chosen individually. Simple excision, suture repair, marginal rotation and tarsal strip procedure may be considered, but in cases of cicatrical entropion or lower lid defect, the main surgical principle involves release of scarred tissue and replacement of the deficient tissue with appropriate graft. We used scapha cartilage only as a spacer, in patients with cicatrical entropion or involutional entropion. The result was satisfactory and the raw surface of the graft facing to the eyeball was epithelialized from the surrounding mucosa within a couple of weeks. We report our concept of scapha cartilage graft and simple technique for the treatment of cicatrical entropion or entropion caused by lower lid defect .

Combination of Stades Forced Granulation Method and Hotz-Celsus Procedure for Treatment of Upper and Lower Eyelid Entropion-Trichiasis in Three Dogs

김영삼,강선미,서강문 한국임상수의학회 2021 한국임상수의학회지 Vol.38 No.1

Three dogs (a 30-month-old spayed female English bulldog; a 12-month-old castrated male English bulldog; a 19-month-old castrated male Shar-pei dog) were presented to the Dana Animal Hospital Eye Center with clinical signs of blepharospasm, epiphora, and ocular discharge (serous to mucopurulent) in one or both eyes. Through ophthalmic examination, the dogs (5 eyes) were diagnosed with trichiasis caused by upper and lower eyelid entropion, including the lateral canthus. To correct upper and lower eyelid entropion, modification using a combination of the Stades forced granulation method for upper eyelid entropion and Hotz-Celsus procedure for lower eyelid entropion was performed in all cases. At the last follow-up, mean 274 days after surgery, clinical signs disappeared and no recurrences of entropion were observed in any of the 3 dogs (5 eyes). Therefore, the combination of the Stades forced granulation method and Hotz-Celsus procedure may be an effective treatment for trichiasis caused by upper and lower eyelid entropion in dogs.

퇴행 아래눈꺼풀속말림 환자에서 비흡수성 봉합사를 이용한 단속 매몰 봉합술의 장기적 효과

김태희(Tae Hee Kim),이경욱(Kyeong wook Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.12

목적: 퇴행성 아래눈꺼풀속말림 환자를 대상으로 비흡수성 봉합사를 이용한 단속 매몰봉합술을 시도하여 장기적 효과와 유용성을 평가하고자 하였다. 대상과 방법: 2010년 1월부터 2015년 1월까지 수평이완의 유무와 관계없이 퇴행성 눈꺼풀속말림을 진단 받은 환자 105명 135안을 대상으로 후향적 분석을 시행하였다. 연축성 또는 반흔성 눈꺼풀속말림 혹은 덧눈꺼풀이 동반된 경우, 과거에 눈꺼풀 수술을 받은 경우, 경과관찰 기간이 3개월 미만인 경우는 연구대상에서 제외하였다. 수술은 비흡수성 봉합사로 눈꺼풀 가운데, 가쪽 2곳에 아래결막구석으로 접근하여 피부로 나오도록 단속 매몰봉합을 시행하였다. 객관적 평가를 위해 임상 사진 분석, 주관적 평가를 위해 문진을 통한 술 전 호소 증상의 호전 정도 그리고 미용적 만족도를 평가하였다. 결과: 평균연령 79.50세, 135안을 대상으로 하였다. 술 전 검사에서 37안(27.4%)에서 수평이완이 있었으며 동일한 수술방법을 시행하였다. 133안(98.5%)에서 아래눈꺼풀속말림이 해부학적으로 해소되었고 증상 호전은 9.44점(0 to 10 scale)이었다. 99명(94.3%)에서 만족스러운 미용 효과를 보았고 추적관찰 34.51 ± 3.8개월 동안 합병증은 없었다. 2명(1.5%)의 재발은 수평이완 환자에서 1명(2.7%), 수평이완이 없는 환자에서 1명(1.0%)이 관찰되었으나 주관적 증상호소는 없었으며 교정은 필요하지 않았다. 결론: 수평이완의 유무와 관계 없이 퇴행성 눈꺼풀속말림 환자를 대상으로 비흡수성 봉합사를 이용하여 단속 매몰봉합으로 간단하게 시행될 수 있는 저자의 봉합술은 장기간의 교정효과를 얻을 수 있으며 재발이 적고 미용적 만족도가 높아 일차적으로 시도해 볼 수 있는 효율적인 방법으로 의의가 있다. Purpose: To introduce and evaluate the long-term effectiveness of interrupted buried suture using non-absorbable material in involutional lower lid entropion. Methods: A total of 105 adult involutional lower lid entropion patients (135 eyes) from January 2010 to January 2015 with or without the horizontal laxity, and without a history of previous surgical treatment were included. Exclusion criteria included patients with cicatricial entropion, epiblepharon, history of previous lower lid surgery, and follow-up period less than 3 months. The central and lateral areas below the lower lid margin and below the inferior tarsal margin were connected by non-absorbable interrupted buried suture. Results were analyzed by objective outcome using measurements from clinical photographs, subjective outcome using improvements of patients’ symptom and cosmetic satisfactions. Results: This study included 135 eyelids. Pre-operative distraction test revealed horizontal laxity in 37 eyes (27.4%). The mean age was 79.50 years and the mean period of follow-up was 34.51 ± 3.8 months. In 133 eyelids (98.5%), post-operative lid positions have everted. Score of symptom improvements were 9.44 (0 to 10 scale). 99 patients (94.3%) were cosmetically satisfied. No surgical complications were observed. Although we had two recurred cases (1.5%), one with horizontal laxity (2.7%) and one without horizontal laxity (1.0%), reoperation was not performed due to mild subjective discomfort. Conclusions: For patients with involutional entropion regardless of horizontal laxity, a simple interrupted buried suture method using non-absorbable suture material showed excellent long term results in very low recurrence rate and high cosmetic satisfaction.

퇴행성 눈꺼풀속말림의 수술방법에 따른 치료결과 분석

윤재문,김선아,노주헌.Jae Moon Yoon. M.D.. Sun A Kim. M.D.. Joo Heon Roh. M.D.. Ph.D 대한안과학회 2008 대한안과학회지 Vol.49 No.12

Purpose: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion. Methods: This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb). Results: The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively. Conclusions: The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure. J Korean Ophthalmol Soc 2008;49(12):1877-1887

Modified everting sutures combined with reattachment to the inferior tarsal plate for involutional lower eyelid entropion: A new technique

Sen, Emine Malkoc,Yalcinsoy, Kubra Ozdemir Korean Society of Plastic and Reconstructive Surge 2020 Archives of Plastic Surgery Vol.47 No.4

Background This study evaluated the outcomes of a new modified Wies technique for patients with involutional lower eyelid entropion without horizontal eyelid laxity. Methods This case series retrospectively analyzed consecutive patients with entropion who underwent surgery between January 2014 and March 2019 by the same experienced surgeon. Horizontal eyelid laxity, lower eyelid retractor function, and orbicularis muscle overriding were recorded before and after surgery. The recurrence rate and complications were also evaluated. This technique consisted of modified everting sutures combined with reattachment of the lower eyelid retractors to the inferior tarsal plate. Results This new technique was performed on 28 eyes in 25 patients (mean age, 71.0±8.0 years; range, 56-87 years). Nine patients (36%) were women and 16 (64%) were men. Lower lid entropion was present in the right eye in 14 patients (56%), the left eye in eight patients (32%), and both eyes in three patients (12%). The mean follow-up period was 27.3±12.4 months (range, 6-60 months). No intraoperative complications were observed. All patients' symptoms were alleviated. One patient (3.6%) had recurrence after 2 years (success rate, 96.4%). The remaining 27 eyes maintained a satisfactory and comfortable eyelid position. No patients had problems with scarring. Conclusions The approach described herein proved to be safe and feasible in eyes with involutional lower eyelid entropion without horizontal eyelid laxity. These advantages of this procedure include the lack of a conjunctival scar, punctal eversion, and lateral canthal angle deformation. A low recurrence rate and a long interval to recurrence were also observed.

가쪽눈꺼풀판띠고정술과 퀴커트 봉합술을 동시에 시행한 퇴행성 눈꺼풀속말림의 치료결과분석

김상원,이우석,노주헌,Sang Won Kim,MD,Woo Seok Lee,MD,Joo Heon Rho,MD 대한안과학회 2012 대한안과학회지 Vol.53 No.9

Purpose: To evaluate long-term effectiveness of lateral tarsal strip procedure combined with Quickert sutures in correcting involutional entropion. Methods: The retrospective study reviewed 82 eyes of 71 patients with involutional entropion whose follow-up period was more than 6 months among patients who underwent lateral tarsal strip procedure combined with Quickert sutures between February 2003 and February 2010. Results: The postoperative follow-up period was 6 months to 78 months (average 40.2 months) and the average age was 63.5 years. Out of 82 eyes, 3 eyes recurred and the recurrence rate in the lateral tarsal strip procedure combined with Quickert sutures was 3.6%; postoperative overcorrection was not observed. Out of the 3 recurrence cases, 2 eyes both recurred 6 months after the operation and were treated by Quickert sutures alone with no recurrence. The other case recurred 1 year and 4 months after lateral tarsal strip procedure combined with Quickert sutures and was corrected by this operation again. There was no recurrence for a follow-up period of 2 years. Conclusions: An effective approach was obtained during long-term follow-up when lateral tarsal strip procedure combined with Quickert sutures was conducted as repairing operations in involutional entropion. The approach showed lower recurrence rate than the existing reports of operations such as lateral tarsal strip procedure or Quickert sutures when conducted alone and provided long-lasting effectiveness in the correction of involutional entropion. J Korean Ophthalmol Soc 2012;53(9):1213-1218

아래눈꺼풀 미용성형술 후 발생한 눈꺼풀속말림에 대한 연구

이용재(Yong Jae Lee),장선영(Sun Young Jang),이상열(Sang Yeul Lee) 대한안과학회 2022 대한안과학회지 Vol.63 No.2

목적: 아래눈꺼풀 미용성형술 후 눈꺼풀속말림이 발생한 환자 34명이 관찰되어 이를 수술적으로 치료하였기에 보고하고자 한다. 대상과 방법: 2015년부터 2021년까지 우리연세안과의원에서 눈꺼풀속말림을 진단받은 환자 중 아래눈꺼풀의 미용성형술을 받은 과거력이 있는 환자 34명을 대상으로 하였다. 환자는 모두 여성이었으며, 이들의 평균 연령은 30.6세였다. 우리연세안과의원 방문 전 받은아래눈꺼풀 미용성형술은 필러주사, 밑트임, 밑트임 및 뒤트임, 혹은 아래눈꺼풀성형술이었다. 결과: 대상 환자들은 눈꺼풀속말림 외에 눈꺼풀뒤당김, 아래눈꺼풀 상방 이동제한이 나타났으며, 정도에 따라 grade I부터 grade IV까지 분류하였다. 모든 환자에서 Hotz법 수술을 시행하였으며, 심한 정도에 따라 필러제거술, 아래눈꺼풀당김기후전술, 경구개점막이식술 등을 추가적으로 시행하였다. 결론: 우리나라 성형외과계에서는 눈을 크게 보이고 싶은 환자들에게 밑트임 혹은 뒤트임이라는 수술로 아래눈꺼풀 미용성형술을시행하고 있다. 이번 보고에서는 아래눈꺼풀 미용성형술 후 합병증으로 많은 수의 환자에서 눈꺼풀속말림이 발생하여 수술이 필요하였다. 이러한 부작용이 발생하는 것을 방지하기 위해서는 수술 전 아래눈꺼풀의 이완 정도, 눈꺼풀틈새의 크기 그리고 형태학적 문제등 눈 상태에 대한 충분한 사전검사가 필요할 것으로 보이며, 환자들에게도 수술의 필요성과 수술 후의 부작용에 대한 충분한 설명이 필요할 것으로 보인다. Purpose: Cosmetic procedures for lower eyelids are popular in the field of plastic surgery for patients who want to make their eyes look bigger in Korea. We have experienced patients who developed entropion after the lower eyelid cosmetic procedure and treated it surgically, and therefore we would like to report on these cases. Methods: From 2015 to 2021, among all patients diagnosed as having entropion at Woori Yonsei eye clinic, 34 patients with a history of lower eyelid plastic procedure were included in this study. Results: All patients were female and their mean age was 30.6 years. We classified subjects from grade I to grade IV according to the degree of resistance to the lower eyelid retraction and lower eyelid upward movement restriction. The Hotz operation was performed in all patients. Filler removal, lower eyelid retraction recession, or palate mucosal transplantation were additionally performed depending on the severity of entropion. Conclusions: After the cosmetic procedure of lower eyelid, some patients had entropion as a complication and required surgery. To prevent these complications, sufficient pre-examination of eye conditions such as the degree of relaxation of the lower eyelid, size of eyelid fissure, morphological problems, and reevaluation of surgical technique are required before the procedure starts. In addition, it seems the patients need to provide with sufficient explanation about the necessity of the procedure and its side effects.

퇴행성 아래눈꺼풀속말림의 치료에 있어 퀴커트 봉합술의 효과

배숭환,김명진,최용준,김성주,Soong-Hwan Bae,Myung-Jin Kim,Yong-Jun Choi,Sung-Joo Kim 대한안과학회 2005 대한안과학회지 Vol.46 No.7

Purpose: To evaluate the effectiveness of the Quickert-Rathbun suture to correct involutional entropion. Methods: A retrospective review was performed of 132 consecutive patients (132 lids, male 58, female 74) with involutional entropion who underwent correction from September 2001 to June 2004 at Kim`s eye hospital. All surgical corrections were performed with the Quickert-Rathbun suture technique. The average follow-up period was 9 months (1~17 months). Results: The average length of follow-up time was 14 months (6~22 months). There were no long-term complications like lagophthalmos or ectropion. Surgery was successful in 102 (77.2%) of the 132 eyelids in the first Quickert-Rathbun suture. The second Quickert-Rathbun suture was performed to 17 out of 30 recurred patients, One of whom was noted to have recurrent entropion at 12 months. The final success rate of Quickert-Rathbun suture was 89.3%. The average length of recurrence time was 9.1±8.4 months. Conclusions: The Quickert-Rathbun suture described is simple, straightforward and reliable for the correction of involutional entropion primarily.

눈꺼풀속말림, 두줄속눈썹 환자에서 시축을 침범한 양안 각막 아밀로이드증

노성래(Sung Rae Noh),양찬민(Chan Min Yang),김태기(Tae Gi Kim),진경현(Kyung Hyun Jin) 대한검안학회 2017 Annals of optometry and contact lens Vol.16 No.2

Purpose: To report a rare case of bilateral secondary corneal amyloidosis with visual disturbance secondary to entropion and distichiasis. Case summary: A 41-year-old man was referred to our clinic for the evaluation of decreased visual acuity in both eyes. Upon admission, the patient’s best-corrected visual acuity was 0.6 OD and count finger OS. External evaluation revealed entropion in both lower eyelids as well as distichiasis involving all 4 eyelids cause irritation to cornea. Slit-lamp examination revealed corneal opacity in the right peripheral cornea and left center cornea. The appearance of corneal opacity is gray-whitish circle with diameter 5 mm in right and 4 mm in left, also presented with gelatinous irregular surface and neovascularization in the right eye. Penetrating keratoplasty was performed for decreased visual acuity in the left eye. Histopathologic analysis of corneal button revealed deposition of amorphous, eosinophilic material just beneath the corneal epithelium. These opacities stained with Congo red and demonstrated apple green birefringence and dichroism. Secondary localized amyloidosis of the cornea was diagnosed without any systemic involvement. Entropion repair and hyfrecation was performed 1 month after penetrating keratoplasty. By the 4 years after penetrating keratoplasty, the patient’s best-corrected visual acuity was 0.9 OD and the patient showed no evidence of corneal graft rejection and recurrence of amyloidosis. Conclusion: Irritation by eyelashes can cause corneal opacity and amyloidosis in patients with distichiasis or entropion.