复发性先天性上睑下垂的手术疗效分析

目的评价复发性先天性上睑下垂的手术疗效。方法15例（15只眼）复发性先天性上睑下垂患者，术前根据患者提上睑肌的肌力结合上次手术方式确定再次手术方式，提上睑肌力〈4mm者采用直视下额肌瓣悬吊术，提上睑肌力≥4mm者采用提上睑肌缩短术，术后追踪随访6-12个月，对手术方式和疗效进行回顾性分析。结果所有病例均获得满意疗效，上睑形态自然，睑缘弧度良好，上睑缘位于角膜缘下1-2mm，双眼基本对侧。结论复发性上睑下垂的再次手术需要个性化处理，仍需要根据提上睑肌肌力来确定再次手术方式。     

上睑下垂术后回退再手术的临床观察

目的 总结上睑下垂矫正术后回退再手术的临床经验.方法 对22例(24只眼)上睑下垂矫正术后回退再次手术的临床资料.结果 22例患者首次手术前均为单眼或双眼中度至重度先天性上睑下垂.首次手术方式:4只眼为额肌缝线悬吊术,3只眼为额肌硅胶悬吊术,7只眼为额肌筋膜瓣悬吊术,10只眼为提上睑肌缩短术.首次手术后出现1只眼上睑缘角状畸形,2只眼上睑内侧内翻倒睫,5只眼睑闭合不全,2只眼浅层点状角膜炎.再次手术方式:4只眼行提上睑肌缩短术,20只眼行额肌筋膜瓣悬吊术,睑缘角状畸形、上睑内翻倒睫及双重睑不对称者术中一并矫正.结论 额肌筋膜瓣悬吊术是上睑下垂矫正术后回退再手术的主要手术方式.     

三种术式治疗重度先天性上睑下垂的疗效对比

目的:探讨提上睑肌缩短术、额肌瓣悬吊术、阔筋膜悬吊术治疗重度先天性上睑下垂的效果。方法:手术治疗重度先天性上睑下垂患者42例47眼,其中提上睑肌缩短术25例28眼、额肌瓣悬吊术10例12眼、阔筋膜悬吊术7例7眼,比较手术效果,上睑弧度、双重睑成形情况及手术并发症情况。结果:采用提上睑肌缩短术者,术后外观自然美观,兔眼恢复时间短,效果满意;采用额肌瓣悬吊术者术后外形欠自然、兔眼恢复时间长;采用阔筋膜悬吊术者,上睑迟滞和眼睑闭合不全较明显,易发生矫正不足。结论:三种手术方式均能有效治疗先天性上睑下垂。提上睑肌缩短术更符合生理状态,手术效果最好且并发症少。     

额肌瓣直接悬吊术的临床疗效观察

提上睑肌功能大部分或完全丧失的先天性和部分后天性上睑下垂患者 ,行提上睑肌缩短或间接额肌提吊等手术 ,不能达到较好的矫正效果 [1 ]。我们对 40例 46眼患者行额肌瓣直接悬吊术 ,现报告如下。1　资料与方法1.1　临床资料　 40例 46眼先天性上睑下垂患者 ,其中男2 8例 ,女 12例 ;年龄 4～ 2 1岁 ,平均 10 .2 5岁 ;6例 6眼为提上睑肌缩短术失败后患者。所有患者眼球运动无异常 ,上直肌功能正常 ,重度上睑下垂 32例 36眼 ,中度上睑下垂 8例10眼。提上睑肌肌力测定 2～ 3mm者 2 4例 2 6眼 ,0～ 1mm者 16例 2 0眼 ,额肌肌力测定均超过 7m m。…     

儿童先天性上睑下垂手术方法探讨

目的观察不同的手术方式矫治儿童先天性上睑下垂的治疗效果。方法对56例（100眼）儿童先天性上睑下垂采用上睑皮肤单切口,分3组：第1组利用额骨膜缝线式吊术,治疗年龄在3月～1．5岁的患儿。第2组利用上睑提肌缩短术治疗上睑提肌肌力为4—8mm的患儿。第3组利用额肌瓣悬吊术治疗上睑提肌肌力为0～6mm的患儿。结果随访6月～2a,额肌瓣组病例全达满意效果,而上睑提肌组12眼,矫正不足,额骨膜缝线悬吊组4眼上睑垂睑线消失。结论额肌瓣悬吊术为矫治儿童先天性上睑下垂的最佳手术方式。     

重度先天性上睑下垂不同术式术后效果的比较

我院 1998～ 2 0 0 1年共收治 4 8例重度先天性上睑下垂患者 ,应用提上睑肌缩短术及额肌瓣悬吊术进行治疗 ,现将结果报告如下。1　临床资料1.1　一般资料　本组 4 8例 76眼 ,男 2 8例 4 5眼 ,女 2 0例 31眼 ;年龄 4～ 2 0岁 ,平均 14 .5岁 ;单眼 2 0例 ,双眼 2 8例。双眼患者上睑下垂程度均符合重度标准[1 ] 。本组病例术前均行睑裂、提上睑肌肌力、眉睑距、额肌肌力测量及 Bell现象检查。其中提上睑肌缩短术 32例 4 8眼 ,额肌瓣悬吊术 16例 2 8眼。1.2　手术方法　提上睑肌缩短术组的手术量以下垂程度及提上睑肌肌力综合确定 ,原则上每矫…     

额肌悬吊术和提上睑肌-额肌吻合术治疗重度先天性上睑下垂

目的 比较额肌瓣悬吊术和提上睑肌腱膜-额肌瓣吻合术治疗重度先天性上睑下垂的疗效.方法 分析分别采用用额肌瓣悬吊术、提上睑肌腱膜-额肌瓣吻合术治疗重度先天性上睑下垂98例133只眼,比较两组手术的疗效.结果 额肌瓣悬吊术组和提上睑肌腱膜-额肌瓣吻合术组矫正上睑下垂的疗效差异无统计学意义(P＞0.05).但前者术后有5例睑缘弧度不自然(6.9%),后者术后睑缘弧度均较自然.结论 额肌瓣悬吊术和提上睑肌腱膜-额肌瓣吻合术都能有效治疗重度先天性上睑下垂,但后者较符合眼睑生理解剖,术后睑缘弧度更自然.     

上睑下垂额肌瓣悬吊术中上睑缘位置控制法探讨

目的 探讨上睑下垂额肌瓣悬吊术中上睑缘位置与手术效果的关系。方法 28例35眼先天性上睑下垂，全部在局麻下采用额肌瓣悬吊术治疗，术中将上睑缘位置矫正到角膜上缘处，术后常规处理，并严密观察上睑缘位置的下降程度。结果 术后随访1～3年，上睑缘位于角膜七缘以下1mm者4眼(11．43％)，2mm者28眼(80．00％)，3mm者3眼(8.57％)。术后上睑缘位置下降2mm，符合正常人上睑缘遮盖上方角膜2mm左右的解剖结构和生理要求。全部病人均获得满意和比较满意的矫正效果。结论 上睑下垂额肌瓣悬吊术术中上睑缘应恰位于角膜上缘处，方可获得良好的手术矫正效果。     

改良式额肌瓣悬吊术治疗先天性上睑下垂的体会

目的:探讨额肌瓣悬吊术治疗先天性上睑下垂的临床效果和方式方法。方法:采用额肌瓣悬吊术治疗先天性上睑下垂患者34例46眼,对术后效果进行随访观察并对疗效进行回顾性分析。结果:本组病例34例46眼随访3～12mo,上睑下垂全部矫正,均获得良好效果。术后3mo满意率96%,基本满意率100%。结论:额肌瓣悬吊术是治疗提上睑肌肌力<4mm的先天性上睑下垂的有效方法,不仅能恢复上睑功能,同时能够达到美观的效果。     

超常量提上睑肌缩短及额肌瓣悬吊治疗重度先天性上睑下垂效果比较

目的：比较提上睑肌缩短术与额肌瓣悬吊术治疗重度先天性上睑下垂的疗效与并发症。

方法：对40例58眼重度先天性上睑下垂患者进行手术治疗,其中,20例28眼行额肌腱膜瓣悬吊术,20例30眼行改良的提上睑肌缩短术,术后随访6mo,观察两种手术方式治疗重度先天性上睑下垂的治疗效果及术后并发症的发生情况。

结果：术后随访6mo,提上睑肌缩短术组及额肌瓣悬吊术组治疗重度先天性上睑下垂的正矫率分别为：83%、82%,差异无统计学意义(P>0.05),但术后并发症的发生,如倒睫、闭合不全、暴露性角膜炎、结膜脱垂等,提上睑肌缩短术组少于额肌瓣悬吊术组,且有更好的外观。提上睑肌缩短术后6mo复诊时,眼睑闭合不全15眼,暴露性角膜炎共1眼,结膜脱垂2眼; 额肌瓣悬吊术后6mo随诊,眼睑闭合不全23眼,暴露性角膜炎2眼,上睑倒睫3眼。

结论：提上睑肌缩短术及额肌瓣悬吊术均能有效矫正重度先天性上睑下垂,但前者并发症少,术后外观好。     

Early Frontalis Flap Surgery as First Option to Correct Congenital Ptosis with Poor Levator Function

Abstract

In congenital blepharoptosis the upper eyelid cannot be lifted normally because of congenital impairment in the levator function. The descended eyelid margin partially or completely obstructs of the visual axis with the consequent risk of amblyopia. Frontalis suspension is the surgery of choice for ptosis with poor levator function creating a linkage between the frontalis muscle and the tarsus; the frontalis muscle is used to elevate the eyelid. Direct transplantation of frontalis muscle to the upper eyelid has been widely described. We report our experience using frontalis flap in congenital ptosis with poor levator function in children.

Methods: Retrospective study of 30 eyes with severe congenital ptosis and poor levator function treated by means of direct frontalis flap. Mean age 2 years. Eyelid measurements were taken at baseline, 1, 3, 12 months postoperatively and last visit. Mean ptosis degree was 5?mm (3--8?mm) and levator function 2?mm (1--5?mm). The presence of complications, flap function and palpebral contour were evaluated. Mean follow up time was 27 months. At last visit, ptosis degree ranged from 0 to 3?mm.

Discussion: Direct advancement of the frontalis muscle to treat severe eyelid ptosis is effective and stable in the long term avoiding the use of a linking structure, therefore the risk of foreign-body reaction, absorption, granuloma and late exposure, as well as the need for a second visible incision in the forehead. Patients learn how to control the lid height by means of the frontalis muscle achieving more symmetry.     

提上睑肌缩短术治疗儿童重度上睑下垂

目的:观察提上睑肌缩短术治疗肌力<4mm的重度先天性上睑下垂的效果。方法:对肌力在4mm以下的重度先天性上睑下垂58例84眼行提上睑肌缩短术,观察并分析术后上睑的高度,睑裂宽度,上睑的弧度及重睑形态。结果:本组病例中,正矫64眼(76.2%);轻度欠矫(上睑缘位于上方瞳孔缘或上方瞳孔缘下1mm)18眼(21.4%),复发(上睑缘高度较术前无提高)2眼(2.4%)。欠矫的病例中有6例伴外侧1/3重睑沟变浅。无过矫病例,无暴露性角膜炎病例。结论:提上睑肌缩短术治疗肌力<4mm的重度先天性上睑下垂可取得满意效果。但在手术的最低年龄及探求少部分失败病例的原因等方面还有待进一步研究。     

Use of the levator muscle as a frontalis sling

PURPOSE: To investigate the use of the distal portion of levator aponeurosis as a flap for frontalis suspension in patients with severe congenital ptosis and poor levator function. METHODS: Eleven procedures were performed on 8 patients with severe congenital ptosis and poor levator muscle function. Three of the 8 patients had Marcus-Gunn jaw-winking phenomenon. Preoperative evaluation included measurements of the degree of ptosis, levator function, superior rectus action, Bell phenomenon, lagophthalmos, and (if present) synkinetic eyelid movement. Surgery involved fashioning a flap from the distal portion of the levator aponeurosis and anchoring it to the frontalis muscle. Postoperatively, patients were followed for at least 6 months to assess the level of the eyelid in the primary position at rest and when the brow is raised, the degree of eyelid margin excursion on brow elevation, persistence of synkinetic eye movement, presence of complications, lagophthalmos, corneal exposure, and symmetry. RESULTS: Synkinetic muscle movements were completely abolished. All cases had good primary eyelid position, no corneal complications, and effective frontalis action on eyelid elevation. CONCLUSIONS: The distal levator muscle flap is an effective frontalis suspension material to correct ptosis with poor levator function and to abolish synkinetic eyelid movement without compromising corneal protection.     

Direct Tarsus to Frontalis Muscle Sling without Flap Creation for Correction of Blepharoptosis with Poor Levator Function

Purpose: To report the outcomes of ptosis surgery in patients with weak levator function utilizing the direct tarsus to frontalis muscle sling technique without creation of a flap.

Methods: In a prospective nonrandomized case series over a 3-year period, patients with ptosis and weak (less than 4?mm) levator function underwent direct sling of the tarsus to frontalis muscle without creating any flap. Success was defined as upper lid margin to central corneal reflex distance of at least 3?mm in bilateral cases and a difference of less than 1?mm in unilateral cases.

Results: Overall, 26 eyes of 22 patients with mean age of 15.4?±?9.4 years were operated and followed up for 13.5?±?8.4 months. The ptosis was congenital in 15 patients (68.2%) and acquired in 7 patients (31.8%). Twelve patients (54.5%) had a history of ptosis surgery. The procedure was judged as successful in 77.3% of patients after initial surgery and in 100% after reoperation. Surgical success after initial surgery was directly correlated with the amount of levator function (P?=?0.02). However, success was not associated with age (P?=?0.9) or history of surgery (P?=?0.9). None of the patients developed eyelid hematoma, lagophthalmus or dry eye.

Conclusions: Direct sling of the upper tarsus to the frontalis muscle without creation of flap is an effective procedure for correction of ptosis in patients with weak levator function. Minimal dissection and preservation of the orbicularis oculi prevents lagophthalmus and its consequences.     

先天性上睑下垂经眶隔后隧道额肌瓣悬吊术

目的 观察经眶隔后隧道额肌瓣悬吊术治疗先天性上睑下垂的临床效果.方法 先天性上睑下垂170例,随机分为观察组和对照组,观察组采用经眶隔后隧道额肌瓣悬吊术治疗,对照组采用上睑提肌缩短徙前矫正术治疗.术后观察6个月,统计对比两组治疗效果及满意度.结果 观察组患者矫正满意度为92.05％,对照组者为71.95％,差异具有统计学意义（x2=13.29,P＜0.05）;观察组有效率为96.59％,对照组者为86.59％,差异具有统计学意义（x2=9.28,P＜0.05）.结论 经眶隔后隧道额肌瓣悬吊术治疗先天性上睑下垂效果明显.有较高的临床价值.     

Direct Frontalis Flap with and without Levator Pulley for Correction of Severe Ptosis with Poor Levator Function in the Same Patient

Purpose: To compare two techniques of frontalis muscle flap suspension in different eyelids of the same patient for correction of severe ptosis with minimal levator function.

Material and methods: A prospective study of four patients with severe bilateral ptosis and poor levator function, who underwent direct frontalis muscle flap on the right eyelid and frontalis muscle flap with levator pulley on the left eyelid was conducted. Eyelid studies measurements were taken at baseline, 2 months, one year and 5 years after surgery. The presence of complications, flap function and palpebral contour were evaluated.

Results: Despite the surgical technique performed, good results in terms of functionality, contour and aesthetics were observed. In the eyes that underwent frontalis muscle flap (FMF)-direct, there were 2 cases with moderate anteriorization of eyelid margin in extreme upgaze and all patients showed eyelash ptosis that persisted one year after surgery, but improved after 5 years. In the eyes that underwent FMF-pulley, no upgaze anteriorization of eyelid margin was observed and three patients had eyelash ptosis of lesser extent than the fellow eye, improving after 1 year follow-up. FMF-pulley showed more long-term stability in eyelid height, compared with FMF-direct.

Conclusions: Frontalis muscle flap with a pulley in the levator aponeurosis prevents some complications caused by the excessive vertical component of the direct frontalis muscle flap, especially in deep-set eye patients, with better stability of the eyelid height and contour over time.     

Advances in the diagnosis and treatment of ptosis

PURPOSE OF REVIEW: The surgical correction of blepharoptosis, both congenital and acquired, has been intensively examined and reported on for many years. This paper reviews recent publications on basic science, evaluation, technique modifications, and innovative materials in the care of ptosis patients. RECENT FINDINGS: The frontalis suspension technique is a commonly performed surgical correction of congenital blepharoptosis, used widely in the repair of ptosis with poor levator function. The repair typically includes using either tissue such as autologous or banked fascia lata or permanent suture material. The procedure involves connecting the motor unit (frontalis muscle) and the upper eyelid. Authors have recently reintroduced the technique of a dynamic frontalis muscle flap tunneled into the eyelid that directly attaches to the tarsal plate.Patients presenting with symptomatic blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. Multiple groups have tended toward a minimally invasive approach directed specifically at the levator aponeurotic defect. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. SUMMARY: Surgical correction of congenital blepharoptosis may be performed with autologous fascia lata, cadaveric allograft, or permanent suture material. The use of a frontalis muscle advancement flap is elegantly designed; however, its role in clinical practice remains to be defined. Advancement of the levator aponeurosis for senile blepharoptosis may be preformed via a minimally invasive small incision approach. Patients benefit with decreased operative time, edema, ecchymosis, and recovery times.