叉形额肌腱膜悬吊法治疗上睑下垂136眼

为了减少额肌损伤,增强肌力,提高额肌腱膜矫治上睑下垂的成功率,应用叉形额肌腱膜悬吊术治疗78例136只眼上睑下垂。其特点是纵向适度劈开额肌腱膜,以充分上提上睑,并均衡地分散上提的拮抗力。经随访36例61侧上睑下垂,最长时间已6年余,证实效果满意可靠,达到预期目的。本法是治疗中度和重度上睑下垂或经其它方法治疗后复发的上睑下垂的优选方法。     

叉形额肌腱膜悬吊法治疗上睑下垂136眼

为了减少额肌损伤，增强肌力，提高额肌腱膜矫治上睑下垂的成功率，应用叉形额肌腱膜悬吊术治疗７８例１３６只眼上睑下垂。其特点是纵向适度劈开额肌腱膜，以充分上提上睑，并均衡地分菜上提的拮抗力。     

改良额肌瓣悬吊术治疗重度上睑下垂临床观察

上睑下垂的手术治疗方法多种多样，至2008年初，我科采用额肌瓣悬吊于提上睑肌腱膜上的方法，治疗重度上睑下垂16例，取得了满意的效果，现报道如下。     

额肌瓣与提上睑肌腱膜瓣吻合矫正重度上睑下垂

目的：探讨额肌瓣和提上睑肌腱膜瓣吻合术矫正重度上睑下垂的疗效。方法：对36例（43眼）重度先天性上睑下垂患者行额肌瓣和提上睑肌腱膜瓣吻合矫正术,术后随防3个月～2年,平均13个月。结果：矫正良好31例,矫正尚可5例,无矫正不良者。结论：额肌瓣与提上睑肌腱膜瓣吻合术矫正重症上睑下垂较传统单纯额肌瓣悬吊术操作简单,损伤小,并发症少,手术成功率高,更符合生理解剖特点,矫正重症上睑下垂安全可靠。     

眶隔筋膜瓣及提上睑肌与额肌瓣吻合悬吊矫正重度上睑下垂

目的：研究利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣悬吊矫正重度上睑下垂的临床效果。方法：术中切开眶隔,形成蒂在睑板上缘的眶隔筋膜瓣,在眉部分离形成额肌瓣,将这两瓣与提上睑肌腱膜重叠缝合固定,建立与额肌的连接,悬吊上睑并矫正下垂畸形。结果：采用此方法对27例35侧重度上睑下垂的眼睑进行了治疗,随访3～6个月,其中31侧眼睑取得了满意的效果,额肌收缩时患睑睁大两侧眼裂大小对称,睑缘位置正常,外形自然,睑缘弧度及重睑外形满意。矫正不足4侧,后行二次手术而修复。结论：利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣重叠吻合悬吊矫正重度上睑下垂,上睑悬吊牢固,不易复发,保持了眼睑的原有结构,睑缘和重睑线弧度及外观满意,畸形矫正效果良好,优于传统的上睑提肌腱膜瓣悬吊和单纯额肌悬吊的方法。     

上睑下垂手术治疗500例

目的 探讨不同种类上睑下垂的手术治疗方法和效果。方法 对500例（620只眼）上睑下垂的手术治疗进行了回顾性总结。上睑下垂的种类包括先天性、神经源性、肌源性、外伤性、机械性和老年性。手术方法包括提上睑肌缩短术、提上睑肌腱膜瓣一额肌吻合术、Whitnall韧带悬吊术、弗．盖氏术、提上睑肌，腱膜修补术和改良Hotz术。结果 总体手术成功率为90．3％（560／620只眼）。疗效不满意的60只眼中过矫5只，欠矫55只（合并睑畸形4只，睑内翻6只，睑外翻2只）。提上睑肌缩短术治疗轻、中度先天性上睑下垂的手术成功率为93．8％。提上睑肌缩短术和提上睑肌腱膜瓣-额肌吻合术治疗重度先天性上睑下垂的手术成功率分别为72．4％和100％。Whitnall韧带悬吊术治疗复发性先天性上睑下垂的手术成功率为90％。弗-盖氏术、Whitnall韧带悬吊术和提上睑肌腱膜瓣-额肌吻合术治疗神经源性和肌源性上睑下垂的手术成功率分别为41．6％、80％和90％。提上睑肌，腱膜修补术治疗外伤性和老年性上睑下垂的手术成功率分别为94．7％和100％。改良Hotz术治疗机械性上睑下垂的手术成功率为93．3％。结论 根据上睑下垂的种类和程度选择适宜的手术方法和完善手术技巧是提高手术成功率的关键。     

提上睑肌腱膜瓣联合额肌瓣悬吊治疗先天性上睑下垂畸形

目的：研究改良的提上睑肌腱膜瓣联合额肌悬吊治疗重度先天性上睑下垂的，临床治疗效果。方法：自2005年8月～2008年3月，笔者采用该方法矫治重度先天性上睑下垂患者20例，年龄6～27岁，单侧8例，双侧12例。手术形成蒂在睑板上缘的的提上睑肌腱膜瓣，并与额肌建立连接，模拟提上睑肌上提眼睑的功能。结果：本组患者20名，术后随访6个月，15例矫正效果良好，4例好转，1例无效，部分患者出现不同程度的眼睑闭合不全，术后2-3月恢复。无明显并发症发生，效果良好。结论：与单纯的额肌悬吊不同，该术式形成的上提眼睑系统更符合生理结构，并且具备动态矫正效果，手术后外形满意、功能良好。     

上睑提肌腱膜瓣-额肌吻合术与上睑提肌缩短及徙前术矫治上睑下垂的疗效对比

目的:探讨上睑提肌腱膜瓣-额肌吻合术与上睑提肌缩短及徙前术对上睑下垂的手术效果差异。方法:选取笔者医院2015年1月-2016年12月实施手术治疗的100例(180眼)重度上睑下垂患者进行回顾性分析,根据手术方法分为上睑提肌腱膜瓣-额肌吻合术组(50例,94眼)、上睑提肌缩短及徙前术组(50例,86眼),比较两组患者的术后手术效果、术后不同时间点的上睑回退量、并发症发生情况。结果:上睑提肌腱膜瓣-额肌吻合术组术后达到1级的有84眼(89.36%)、达到2级的有10眼(10.64%);上睑提肌缩短及徙前术组术后达到1级的有63眼(73.26%)、达到2级的有18眼(20.93%),两组比较差异有统计学意义(P0.05)。术后6个月、9个月、1年,上睑提肌腱膜瓣-额肌吻合术组的上睑回退量均显著低于同一时间点的上睑提肌缩短及徙前术组,差异有统计学意义(P0.05)。上睑提肌腱膜瓣-额肌吻合术组的术后并发症发生率为4.26%显著低于上睑提肌缩短及徙前术组的15.12%,差异有统计学意义(P0.05)。结论:上睑提肌腱膜瓣-额肌吻合术治疗上睑下垂手术效果可靠、术后上睑回退量小、手术并发症少。     

提上睑肌腱膜缩短术治疗老年性上睑下垂

目的 探讨提上睑肌腱膜缩短术治疗老年性上睑下垂的临床疗效.方法 对7例(111眼)老年性上睑下垂患者,应用新斯的明试验排除重症肌无力后,行提上睑肌腱膜缩短术矫治上睑下垂.结果 本组所有患者术后上睑缘达角膜上缘以下1～2 mm水平,上睑凹陷得到矫正.结论 提上睑肌腱膜缩短术,是矫治老年性上睑下垂的有效方法.     

提上睑肌腱膜瓣──额肌吻合术治疗重度上睑下垂（附30例报告）

本文报告了作者采用提上睑肌腱膜瓣──额肌吻合术治疗重度上睑下垂３０例（３６只眼），手术后上睑下垂矫正和美容效果均非常满意。介绍了该手术主要方法和步骤。讨论了手术的机理、优点和注意事项等。     

扇形额肌筋膜瓣悬吊治疗上睑下垂

目的：探计上睑下垂的较好治疗方法，以改进治疗效果方法：设计井应用扇形额肌筋膜瓣悬吊治疗上睑下垂，结果应用本方击治疗上睑下垂83倒，126只眼，致采满意。其中43例经3个月-10年随访，除3例(4只眼)下垂复发外，其余均取得了良好效果，未见其他并发症发生。结论：本方法的主要特点是扇形筋膜瓣有丰富的血供，并且能均衡覆盖在睑板上以充分上提上睑，符合生理和解音4的要求。     

上睑提肌内限制韧带松解在治疗先天性上睑下垂中的意义

目的 在睑板上缘附近的上睑提肌内，有跨于内外眦角之间数条横向纤维束带即限制韧带，我们探讨其在治疗先天性上睑下垂中的意义。方法 将此韧带松解，可基本矫正大部分经度上睑下垂病例。若为轻，中度上睑下垂，且韧带松解后上睑仍有部分下垂，还需进行睑提肌腱膜折叠术。重度上睑下垂韧带松解后，还需进行眉区额肌筋膜瓣悬吊术。结果 本组27例随访3个月～1年，27例40只眼中38只眼轻、中、重度上睑下垂均矫正满意，2只眼良好，未见睑下垂复发。结论 松解上睑提肌内限制韧带，有助于恢复上睑提肌睑功能，易于矫正睑下垂且手术创伤小，形态自然，不易复发。     

重睑成形术后发生上睑下垂的原因分析及其防治

目的 探讨重睑术后发生上睑下垂的原因及早期防治方法，避免术后医疗纠纷的发生。方法 对拟做重睑术的患者，术前详细询问病史并认真查体。对18例术前发现有睁眼乏力或轻度上睑下垂者，采用切开法重睑术并同时行上睑提肌缩短术，对3例切开法重睑成形术后，出现上睑下垂并发症者即刻打开切口行上睑提肌缩短术；对5例埋线法术后出现上睑下垂者在7d内拆除缝线，重新设计重睑线。无论切开法或埋线法，如超过10d即均在3个月后再行切开法重睑成形术。结果 对26例术前存在或术后发现的轻度上睑下垂者重行手术修复，24例随访3个月至2年，医者与受术者双方满意或基本满意。结论只要遵循预防为主、早期发现、早期治疗的原则，重睑成形术后出现上睑下垂这一特殊并发症是可以治愈的。     

Strategies for Simultaneous Double Eyelid Blepharoplasty in Asian Patients With Congenital Blepharoptosis

Background Most patients with blepharoptosis prefer to undergo a double eyelid operation and a ptosis repair simultaneously to achieve the optimal cosmetic and functional result. However, it is difficult to achieve symmetry in patients with blepharoptosis. Methods Surgery was performed on the levator aponeurosis or frontalis muscle to correct blepharoptosis while double eyelid surgery was simultaneously performed to correct blephroptosis in 264 patients over the past 15 years. This report describes 39 representative cases of unilateral congenital blepharoptosis and 30 representative cases of bilateral congenital blepharoptosis. In cases of unilateral ptosis with good or fair levator function, a levator resection or plication was performed, and the position of the lid margin was adjusted to 1 to 2 mm below the upper limbus. Cases of severe unilateral blepharoptosis were corrected by frontalis muscle flap, orbicularis oculi muscle flap, or frontalis myofacial flap, and the height of the double eyelid was created to be 1 to 2 mm less than the height on the normal side. The position of the lid margin was adjusted to the level of the superior limbus, and the height of the lid crease of the ptotic eye was determined to be according to that on the nonptotic side. For bilateral ptosis patients with equal levator function, the height of the double eyelid was designed symmetrically. Bilateral blepharoptosis patients with unequal levator muscle function should have the double eyelids on both sides created the same as in normal cases, and they must be grafted in proportion to the severity of the blepharoptosis. If the results are unpredictable, the two-stage operation should be performed. Results Only 30% of the eyelids in this study were perfectly symmetric after the blepharoptosis operation, with 70% asymmetric. These 70% showed good symmetry immediately after surgery, but asymmetry occurred 6 months after the operation. Conclusion In blepharoptosis surgery, different techniques for double eyelids must be applied according to the method of ptosis correction used. Usually, the height of the double eyelid on the ptotic side should be a little less than the normal double eyelid height on the nonptotic side. However, it is difficult to achieve symmetric double eyelids in blepharoptosis patients.     

109 cases of blepharoptosis treated by forked frontalis muscle aponeurosis procedure with long term follow-up.

109 cases of severe or recurrent blepharoptosis have been treated with the forked frontalis muscle aponeurosis (FFMA) technique since 1989. In comparison with other frontalis muscle flap (FMF) protocols, this technique has three advantages: (i) no skin incision in the lower rim of the eyebrow; (ii) no incision in the frontalis muscle; and (iii) no dissection under the frontalis muscle. The FFMA is formed at the junction of the frontalis and orbicularis muscles. The 9-year follow-up shows that this is a highly effective procedure. The postoperative function of the frontalis muscle is good and the lack of damage has been confirmed by EMG. There are a few complications such as the sluggishness of the upper eyelid on downward gaze and the possibility of asymmetrical brow height in unilateral blepharoptosis. However, this technique may serve as the best choice in the treatment of severe or recurrent blepharoptosis.     

Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous levator muscle resection

Based on the detailed anatomy, the orbicularis oculi muscle and the orbital septum are the continuation of the frontalis muscle and its fascia. Therefore, the shortened orbicularis oculi muscle and orbital septum would transmit the frontalis muscle action more effectively. The superior-based orbicularis oculi muscle and orbital septum flap, as a single flap, were advanced and attached to the tarsal plate for the correction of blepharoptosis. Six patients with undercorrected blepharoptosis were included in this study. Each patient had undergone more than two levator resection procedures by ophthalmologists or plastic surgeons. Conventionally, the frontalis suspension procedure was the next choice in these cases. The shortened orbicularis oculi muscle and orbital septum flap was used in these cases. Postoperative results were satisfactory after 3-year follow-up.     

Blepharoptosis due to Kearns-Sayre syndrome.

A 16-year-old patient suffering from Kearns-Sayre syndrome presented with severe blepharoptosis. A levator advancement procedure was performed. It seems that in conjunction with medical treatment, blepharoptosis surgery offers good and hopefully long lasting results to patients suffering from this rare syndrome.     

The anterior layer of the levator aponeurosis in blepharoptosis correction

Background: Conventional aponeurotic surgery for blepharoptosis has many advantages, but there is a potential for recurrence and lagophthalmos. The anatomy of the levator palpebrae muscle is relatively well studied, but the relationship of levator aponeurosis with surrounding layers is still controversial. This study aims to prove the presence of an anterior layer of the levator aponeurosis in clinical cases and to describe a technique involving its use for obtaining predictable outcomes in blepharoptosis correction.Methods: Between January 2014 and October 2018, 173 patients with blepharoptosis underwent correction surgery that involved relocating the anterior layer of the levator aponeurosis. During this procedure, after retracting the preaponeurotic fat pad, we could identify the misinserted anterior layer of the levator aponeurosis on the floor of the fat pad. The anterior layer was divided and advanced with posterior layers to 2 mm below the upper margin of the tarsus. After surgery, patients were followed up for 1 year, and surgical outcomes were evaluated.Results: After 1 year of follow-up, 95.4% of the examined patients showed good long-term outcomes. Moreover, although 4% showed moderate outcomes and lost the double eyelid skin crease, there was no ptosis recurrence in these patients and no lagophthalmos occurred in any of the 173 patients.Conclusions: The authors found the misinserted anterior layer of the levator aponeurosis at the floor of preaponeurotic fat pad in blepharoptosis patients. Relocation of the anterior layer can provide predictable outcomes without lagophthalmos in blepharoptosis correction.     

离断眶隔脂肪与上睑提肌腱膜之间的纤维条索治疗轻度上睑下垂

目的探讨治疗轻度上睑下垂的简便方法。方法 2011年以来,对12例轻度上睑下垂患者行上睑下垂矫正术,手术松解离断眶隔脂肪与上睑提肌腱膜之间的纤维条索以矫正上睑下垂。结果本组12例患者,9例患者上睑下垂得到矫正,3例有所改善。术后随访1年,均未见复发,效果满意。结论离断眶隔脂肪与上睑提肌腱膜之间的纤维条索,可矫正轻度上睑下垂,方法简单,效果可靠。