Skin redraping法による内眼角贅皮矯正を併施したHotz法

Application of the Skin Redraping Method to Enhance the Efficacy of the Hotz Procedure in Epiblepharon Treatment

はじめに

　下眼瞼の睫毛内反症は，睫毛が眼球に接触することで涙目や異物感，角膜障害を引き起こす疾患である。東洋人集団において，新生児の睫毛内反症の発症率は46 ％とされており，成長に伴って低下し，12歳ごろには約2 ％まで低下する。自然軽快が望める疾患ではあるが，4～5歳以降では成長による改善が期待しにくく，眼痛と視力低下を認める症例では適切な治療が必要とされている 1）。Hotz法 2）は，簡便かつ安全性が高い治療法として広く用いられているが，内眼角贅皮を伴う症例では矯正が不十分となり，再発が課題となっている 3）。内眼角贅皮を形成する眼輪筋の過剰な上下方向の牽引が皮膚の緊張を生み，涙湖方向への皮膚の牽引が睫毛の内反を助長する。このような症例では，審美的な内眼角形成術を行うのではなく，筋緊張の解除を主目的とする治療が適している。

　本術式では，Ohらが報告したskin redraping法 4）を応用し，内眼角部の筋緊張を解除しつつ自然な形態を保ちながら，睫毛内反症の改善を図る。本稿ではその術式の意義と具体的手技，ならびに2015年4月～2024年9月まで同一術者が施行し，180日以上経過観察した症例の臨床成績について詳述する。

　Purpose: To assess the efficacy of combining a skin redraping (SR) epicanthoplasty with the Hotz procedure for lower eyelid epiblepharon, focusing on recurrence and reoperation rates compared to the application of the Hotz procedure alone.

　Methods: In this retrospective single-surgeon study, patients with epiblepharon who underwent an initial surgery between April 2015 and September 2024 at a tertiary hospital were included if their follow-up was >180 days. We divided the eyes into two groups: those that underwent solely the Hotz procedure (n=37) and those that underwent Hotz + SR (n=81). Recurrence was defined as patient-reported lash inversion or irritation, or requiring reoperation based on the need for the surgical correction of corneal epithelial injury. The groupsʼ patient ages and follow-up duration were compared using the Mann-Whitney U-test. Recurrence and reoperation rates were compared with Fisherʼs exact test (α = 0.05).

　Results: The mean patient age was 20.6 ± 5.4 years in the Hotz group and significantly lower at 15.6 ± 4.8 years in the Hotz + SR group (  p = 0.002); the groupsʼ mean follow-up durations were similar (379.7 ± 143.2 vs 390.5 ± 162.8 days, respectively, p = 0.68). Recurrence occurred in 10/37 eyes (27.0%) after Hotz-alone and in 3/81 eyes (3.7%) after Hotz + SR (odds ratio [OR] 9.6, 95% confidence interval [CI]: 2.4–38.5, p = 0.0005). Reoperations were required in 3/37 eyes (8.1%) in the Holtz group and 1/81 eyes (1.2%) in the Hotz + SR group (OR 7.1, 95%CI: 0.7–70.2, p = 0.09).

　Conclusions: Adding skin redraping to the Hotz procedure significantly reduced the recurrence of epiblepharon while maintaining low reoperation rates, which indicates that skin redraping is a valuable surgical option for cases involving medial epicanthal folds.