目的 探讨直视下锐针注射法将自体脂肪移植填充于腱膜前脂肪来矫正上睑凹陷的临床效果.方法 自2017年6月至2019年12月,首都医科大学附属北京友谊医院医学美容中心和首都医科大学附属北京世纪坛医院整形外科采用直视下自体脂肪颗粒锐针注射移植矫正上睑凹陷136例,分为重睑术后上睑凹陷组(103例)、老年性上睑凹陷组(33例),分析及评估术后效果.结果 所有患者上睑凹陷均得到了矫正,外观较满意,形态较好,移植脂肪未出现团块及明显移位等情况.其中重睑术后上睑凹陷组有5例患者因术前上睑瘢痕粘连严重、腱膜前脂肪缺失较多,4例行二次修复手术,1例未行手术治疗.重睑术后上睑凹陷组满意度为86.4％,老年性上睑凹陷组满意度为90.9％.结论 直视下腱膜前脂肪内自体脂肪锐针注射填充法可以精准矫正上睑凹陷,补充腱膜前脂肪,定位准确,填充量易于控制,移植脂肪颗粒成活良好.该方法适宜临床推广.

目的 介绍一种新的重睑修复术前拍照的理念和方法,改进重睑修复术前照相流程,收集更完整的信息,从而提升重睑修复决策过程的准确性.方法 在接诊重睑修复患者的过程中,首先将患者不满意处进行多角度拍照,与患者沟通并确认.明确患者主要诉求后,按照六步照相法进行眼部标准体系照相,与患者共同进行系统分析.结合分析结果及患者诉求,就遗漏或新发现的关注点,再次进行检查并补充拍照.最后再次与患者共同分析,形成合理的修复方案.结果 通过患者共同参与的多环节拍照和开放式问诊,提高患者对多环节多角度拍照的接受程度和依从性,可以更充分地展现其诉求点.接诊医生通过多环节多角度拍照可以避免疏漏,掌握患者眼部及整体的更多信息,形成更为合理的修复方案.结论 诊察性三段式照相法,由医生与患者共同参与,可提高患者主动性,患者诉求和目前状况得到充分显现.在得到全面影像资料的同时,更能体现以患者为中心的医疗理念,方法值得推广.

目的 探讨"修旧如新"原则在重睑修复术中的应用及临床意义.方法 从2016年5月至2019年12月,我们运用"修旧如新"原则进行了153例(278眼)重睑修复术.在手术设计、手术实施、解剖结构恢复与调整、术后康复以及评估手术效果等环节均遵守和应用"修旧如新"原则.结果 "修旧如新"原则使术者面对不同情况的重睑修复患者时,在术前评估、方案制定、手术实施、术后评估等环节做到规范化,有章可循.可以提高术后满意率.结论"修旧如新"原则有助于重睑修复手术处理方法规范化和系统化,具有临床指导意义,该方法简单、实用,值得推广.

目的 探讨重睑术后缝线经睑结膜面突出的睑板镊辅助下的临床检查和治疗.方法 自2015年1月至2019年7月,共接诊重睑术后缝线经睑结膜面突出的患者11例,患者均在睑板镊辅助下进行检查并治疗.分析缝线突出原因及治疗效果.结果 11位患者均为重睑术后缝线经结膜面外露.患者术后恢复良好,结膜很快愈合.患者术后随访6～12个月,均无复发.结论 重睑术后出现眼部异物感时,应考虑缝线外露的可能性,并及时探查原因.采用睑板镊辅助可以提高检查阳性率,操作简便,易于临床开展.

Objective To explore the practicability and reproducibility of judgment method and assessment indexes for the end point of double eyelid surgery using 4+1 photography in supine position. Methods From 2017 October to 2018 October, 158 patients were included and randomly divided into 2 groups. Photos were taken by 4+1 photography in supine position of 79 patients, while other 79 patients in control group were evaluated by traditional observation. By 4+1 photography in supine position, the surgeon stood at the head side of the patient, taking photos with eyes movement:looking straight forward, looking up, looking downward and eye-closed. It was to observe the upper eyelid creases, upper and lower tissues ofdouble eyelid creases, and upper and lower eyelid margo palpebrae. In addition, the surgeon looked from patient's feet to observe the indexes such as upper margo palpebrae, to make a decision whether the surgery could finish. In control group, the surgeon observed the upper eyelid creases, upper and lower tissues of double eyelid creases and upper and lower eyelid margo palpebrae. The patient has to sit if necessary. Results All 158 patients were performed double eyelid surgery successfully. Average times of valuating end point was 1. 20 by 4+1 Photography in supine position, and 1. 53 in control group. The operation time of 4+1 photography group is (151.65±21.58) s, and control group were (241.53±33.53) s. The satisfaction level was increased to 89. 87％ in 4+1 photography group, compared to 78. 48％ in control group. Conclusions The 4+1 Photography method is simple and easy to practice. The observation indexes are accurate and comprehensive. It is useful in determining the end point of double eyelid plasty in supine position.

细胞因子与PVR形成密切相关。HGF通过自分泌或旁分泌方式作用于RPE和神经胶质细胞,导致RPE活化和胶质细胞迁移;通过活化磷脂酰肌醇3激酶促使神经胶质细胞产生血管内皮生长因子(VEGF)。PDGF-AA通过与含有α亚基PDGFR作用促进PVR形成,但表达PDGFβ受体的细胞不能诱导PVR发生。肌样成纤维细胞聚集是PVR中导致牵拉性视网膜脱离的重要因素,其α平滑肌肌动蛋白的表达依赖于TGF-β2RⅡ及TGF-β1在增生膜中的表达。IL-6是PVR形成的危险因素,是视网膜脱离术后PVR复发的重要预测指标。TNF-α可与RPE表面TNF受体作用并通过MAPK通路诱导RPE细胞高表达α1与α5型整合素,进而促进RPE在PDGF介导下的细胞转移。MCP-1可能在PVR早期起重要作用。