提上睑肌缩短术矫正临界重度先天性上睑下垂

目的评估提上睑肌缩短术矫正临界重度先天性上睑下垂的疗效。方法收集22例（27眼）临界重度先天性上睑下垂患者,患眼均接受提上睑肌缩短术,其中2例（2眼）眼球上转受限患者适当欠矫。术后3～6个月定期随访1次,评估上睑缘位置和角膜状况。结果随访4—46个月,矫正患者中16例（20眼）双眼上睑高度基本对称,3例（4眼）上睑下垂轻度复发,1例（1眼）完全复发。2例欠矫患眼上睑位置无明显变化。未见暴露性角膜炎、结膜脱垂或倒睫等并发症。结论提上睑肌缩短术可有效矫正临界重度先天性上睑下垂。     

Medpor种植体在眼科重建术中的应用

目的：Medpor外科种植体在眼睑重建术中的应用价值。方法：采用Medpor外科种植体施行眼睑重建术,术后随访4－24月（平均8月）5例,观察其疗效。结果：W一部患者术后眼睑形态恢复,外观满意、无一例感染或植入物脱出。结论Medpor是一种较为理想的植入材料,为眼科临床整形术提供了一种可利用的材料。     

Investigation of goldmann perimetry in evaluation of patients for upper eyelid blepharoplasty

Purpose: To determine if preoperative Goldmann Visual Field (GVF) testing in patients with functional dermatochalasis accurately depicts the postoperative superior visual field (SVF) outcome.

Methods: A prospective cohort study was done to compare preoperative and postoperative GVF field tests in patients undergoing upper eyelid blepharoplasty for treatment of dermatochalasis. This study was conducted in accordance with the Declaration of Helsinki and approved by the University of Arkansas for Medical Sciences institutional review board. A preoperative GVF was obtained with the eyelids in the natural position (untaped) and then again with excess skin elevated (taped). One month post-blepharoplasty, another GVF was conducted with eyelids untaped. The pre- and post GVF tests were analyzed to determine if preoperative testing accurately predicts the SVF improvement post-blepharoplasty.

Results: Forty-six eyelids (23 patients) who underwent blepharoplasty for dermatochalasis were included. The preoperative testing underestimated 76% (35/46) of cases by a mean of 61%; and overestimated the final outcome in 24% (11/46) of cases by mean of 23%. Overall, the preoperative GVF testing underestimated the postoperative outcome by a mean of 35%.

Conclusion: Improvement of the SVF after a blepharoplasty is typically greater than the preoperative GVF testing predicts.     

The effect of upper eyelid blepharoplasty on eyelid and brow position

This article evaluates the effect of upper eyelid blepharoplasty on eyelid margin position and brow height. This study is a retrospective analysis of patients who underwent upper eyelid blepharoplasty without concurrent blepharoptosis repair or brow surgery. The medical records of the participants were retrospectively reviewed and an established image analysis software was used to quantify the upper margin reflex distance (MRD1) as well as brow height using high quality standardized clinical photographs. A total of 19 patients (38 eyelids and brows) met the inclusion criteria. The mean preoperative MRD1 was 2.8 mm, and the mean post-operative MRD1 was 3.5 mm, revealing an increase of MRD1 from upper blepharoplasty alone of 0.7 mm (p = 0.0001). The mean preoperative brow position was 17.5 mm above the pupil, and the mean post-operative position was 17.4 mm, for an average change of position of -0.2 mm (p = 0.39) following upper eyelid blepharoplasty. Upper eyelid blepharoplasty without ptosis surgery results in a statistically significant increase in MRD1. Brow position does not demonstrate a statistically significant change in patients who undergo upper eyelid blepharoplasty for simple dermatochalasis.     

眼袋分型与下睑成形术的改进

目的 根据不同年龄及各型睑袋情况选择下睑成形术不同的改进术式,并观察其效果。方法 对73例20－72例睑袋者,根据睑袋分型,选择膨出脂肪或肥厚眼轮匝肌去除、眶脂释放保留眶缘填充固定、眼轮匝肌瓣及外眦韧带悬吊固定等手术方式。结果 术后及随访结果表明,许行适应不同睑袋类型的下睑成形术的改进术式,效果满意,并发症少。结论 下睑袋成形术的改进以加强下睑前壁张力为基础,设计适应于各型眼袋的整复方法是手术成功的关键。     

Assessment of Eyebrow Position Before and After Upper Eyelid Blepharoplasty

Objective: Assess the occurrence of secondary brow ptosis after upper lid blepharoplasty.

Methods: Forty-five individuals (n?=?90 brows) submitted to upper lid blepharoplasty, were assessed by means of a comparative analysis using pre- and post-operatively digital photographs, in the primary position of the eye. The images were processed using ImageJ “software”, transferred to a computer, to an electronic Microsoft Excel 2002^® worksheet. Angular measurements were used, taking the lateral canthal angle of the brow, the most medial point of the brow, the medial canthal angle and the lateral canthal angle of the lid as anatomical reference points. When the outer angles were reduced or the inner angles increased after surgery this was considered a brow ptosis. Individuals who had undergone lid surgery associated with the eyebrow, previous eyebrow surgery and those with eyelid ptosis were excluded. The difference between the pre-operative and post-operative measurements were analyzed statistically using the Student’s t-test for paired samples and the angular variation was compared with their corresponding contralateral sample using Wilcoxon’s non-parametric test.

Results: The measurements obtained after the blepharoplasty show significant variations from those before the surgery, indicating that the correction of redundant tissues in the brow accentuates the tendency of the eyebrow to move down. The alterations are more important in the lateral portion of the eyebrow and they occur bilaterally.

Conclusion: The assessment of angular measurements obtained pre- and post-operatively showed that there are secondary changes in the position of the eyebrow as a result of upper eyelid blepharoplasty.     

黄金分割律在改良型埋线法重睑术中的应用

目的介绍一种方法简便、术后重睑自然而持久的术式。方法采用黄金分割律找到黄金分割点,并用亚甲蓝划出重睑线,并以黄金分割点为中心,设计出等距离的近内眦、外眦部二点。此时,采用改良型埋线法,进行重睑术。结果经3个月随访,未见重睑消失。结论把黄金分割律应用到埋线法重睑术中,具有符合每个人自身的生理、解剖位置和美学标准。     

Small margin (2 mm) excision of peri-ocular basal cell carcinoma with delayed repair

Successful surgical treatment of peri-ocular basal cell carcinomas requires complete excision. Mohs' micrographic surgery achieves this, but is not readily available in all hospitals. The standard 3-4 mm margin does not guarantee complete excision and histology is often not available until after a repair has been undertaken. The 3-4 mm margin has evolved to deal with all forms of BCC. In our opinion, this margin is unnecessarily large for nodular/ulcerative BCC. We report our interim results of excision of localised BCCs using a 2 mm margin in conjunction with a delayed repair following confirmation of histological clearance. Thirty-one patients were treated in this manner; there have been no recurrences after an average follow-up period of 36 months (range 24-57 months).     

全麻下提上睑肌腱膜折叠术矫正轻度先天性上睑下垂

目的:观察探讨全身麻醉下提上睑肌腱膜折叠术矫正轻度先天性上睑下垂的临床疗效及影响疗效的因素。方法:依照术前所测得有关数据对37例40眼确诊为轻度先天性上睑下垂的小儿实施全身麻醉下提上睑肌腱膜折叠术,记录并分析其临床资料,进行疗效评估。结果:患者37例40眼中矫正满意者31眼(78%),欠矫者5眼(12%),过矫者1眼(2%),回退者3眼(8%)。结论:全身麻醉下提上睑肌腱膜折叠术矫正轻度先天性上睑下垂疗效肯定,是治疗轻度先天性上睑下垂的主要方法之一。     

动眼神经麻痹手术治疗临床疗效观察

目的:观察11例动眼神经麻痹患者手术的治疗效果。方法:对11例动眼神经麻痹进行详细临床检查,根据临床检查制定手术方案,将术后结果与术前进行对比。结果:患者11例均行外斜视矫正术,其中有9例患者行外斜视矫正术联合上睑下垂矫正术,术后均取得满意效果。结论:详细的术前检查和合理的手术方案对动眼神经麻痹的治疗具有重要意义。     

Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

AIM: To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis, to determine the appropriate timing of the phenylephrine test, and to assess the responses of the upper and lower eyelids. METHODS: This was a retrospective analysis of 140 eyes of 87 patients (mean age 52.29±16.45y; 22 males, 65 females) with upper eyelid ptosis. Totally 88.6% had aponeurotic and 11.4% had congenital ptosis. For the evaluation of the responses of the upper and lower eyelids to topical 2.5% phenylephrine, the scleral show height, the marginal reflex distance (MRD) between the inferior margin of the upper eyelid and pupillary light reflex (MRD1), and between the central portion of the lower eyelid and pupillary light reflex (MRD2) were measured at the 2nd, 5th, and 15th minutes. The changes of MRD1 and MRD2 with time (ΔMRD1 and ΔMRD2) were evaluated. RESULTS: The mean MRD1, MRD2, and scleral show heights increased within 5min after testing, remaining largely stable between the 5th-15th minutes. The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis (P<0.05). Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis. The mild ptosis group had lower scleral show measurements and higher ΔMRD2 values. The ΔMRD1 and ΔMRD2 values were poorly correlated in all measurement times. CONCLUSION: Performing the phenylephrine test 5min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids. The upper and lower eyelid responses in phenylephrine testing are poorly correlated. However, the ΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor. Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.     

Comparison of minimally invasive glaucoma surgery with trabecular micro-bypass stent and microhook ab interno trabeculotomy performed in conjunction with cataract surgery

AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook (μLOT) or a single iStent® trabecular bypass implantation (iStent) in eyes with cataract and mild-to-moderate glaucoma.METHODS: This study enrolled subjects with mild-to-moderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90y of age. Patients underwent cataract surgery cooperated with either implantation of an iStent (iStent-phaco) or excisional goniotomy with the μLOT (μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while iStent-phaco was carried out on the other eye. Intraocular pressure (IOP) pre- and post-surgery, alterations in anterior chamber flare (ACF), and corneal endothelial cell density (ECD) were estimated.RESULTS: Twenty subjects were enrolled (mean age: 73.6±7.3y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the iStent eyes. The mean final IOP at 12mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the iStent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30d postoperatively, with a value of 11.4 pc/ms. In the iStent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7d postoperatively (11.2 pc/ms at day 7), demonstrating that postoperative inflammation was less in the iStent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, iStent and μLOT are both effective through 12mo of follow-up. Safety is more favorable in the iStent eyes, based on early anterior chamber inflammation.     

两种术式修复上睑下垂额肌瓣悬吊术后重度欠矫的疗效比较

目的:观察上睑下垂额肌瓣悬吊术后重度欠矫的患者再修复的治疗效果.方法:将上睑下垂额肌瓣悬吊术后重度欠矫患者46例67眼随机分为两组:A组23例33眼采用联合筋膜鞘(conjoint fascial sheath,CFS)悬吊术进行修复;B组23例34眼采用Whitnall韧带悬吊术进行修复,术后随访6mo,通过统计分析,比较两种术式的矫正有效率、复发率及术后不良反应.结果:我院采取该两种术式对上睑下垂额肌瓣悬吊术后重度欠矫患者均有较高的矫正有效率,但两种术式矫正有效率的差异不具有统计学意义(P>0.05);Whitnall韧带悬吊术修复的患者复发率小于CFS悬吊术,但差异不具有统计学意义(P>0.05);CFS悬吊术后眼睑闭合不全发生率小于Whitnall韧带悬吊术,差异有统计学意义(P<0.05).结论:CFS悬吊术及Whitnall韧带悬吊术对于额肌瓣悬吊术后重度欠矫的上睑下垂患者均有较高的矫正有效率和较低的复发率,Whitnall韧带悬吊术具有损伤小、易操作等优点,而CFS悬吊术具有可重复性强、眼睑闭合不全发生率低等优点.     

The Prevalence of Ptosis and Its Association with Amblyopia and Strabismus in 7-Year-Old Schoolchildren in Iran

Abstract

Purpose: To determine the prevalence of ptosis (congenital/acquired) in Iranian children aged 7 years and its relationship with amblyopia and strabismus.

Methods: Eight Iranian cities were selected for this cross-sectional study using multistage randomized cluster sampling. A number of primary schools were randomly selected in each city. All grade 1 students in each selected primary school underwent optometric examinations including the measurement of uncorrected and corrected visual acuity, cover test, and cycloplegic and non-cycloplegic refraction.

Results: Of 4614 selected students, 4106 students participated in the study (response rate?=?89%). The prevalence of ptosis (congenital/acquired) was 1.41% (95% CI 1–1.83); 0.49% (95% CI 0.26–0.72) and 0.93% (95% CI 0.59–1.26) had unilateral and bilateral ptosis, respectively. The prevalence of ptosis had no significant correlation with sex (p?=?0.810, OR?=?1.07, 95% CI 0.59–1.97). The prevalence of amblyopia was 48.28% and 0.89% in students with and without ptosis, respectively. The prevalence of tropia was significantly higher in cases with bilateral ptosis (p?<?0.001). The mean cylinder error was 1.63?±?1.72 and 0.44?±?0.60 in ptotic and non-ptotic eyes, respectively (p?<?0.001). With-the-rule (WTR) astigmatism was significantly more prevalent in students with ptosis.

Conclusion: We report the prevalence of ptosis (congenital/acquired) in children in Iran and the Middle East region for the first time. Amblyopia was considerably more prevalent in ptotic patients. We found a significant correlation between ptosis and tropia. Astigmatism, especially WTR stigmatism, was more prevalent in children with ptosis.     

两种不同浓度的A型肉毒素注射治疗眼睑痉挛的观察对比

目的：观察两种不同浓度的A型肉毒素（ BTX－A ）治疗眼睑痉挛的疗效及不良反应。方法：将220例440眼患者（2013－01／2015－01来我科确诊为眼睑痉挛患者）随机分为高浓度组110例和低浓度组110例,分别采用40 U／mL和25 U／mL浓度局部注射到上下眼睑轮匝肌、皱眉肌、降眉肌、降眉间肌。观察两组BTX－A的用量、治疗效果、维持时间及不良反应。结果：高浓度组BTX－A的用量为48．33±4．02U,低浓度组BTX－A的用量为28．51±3．42U,差异有统计学意义（ P＜0．05）,而高浓度组与低浓度组术后疗效评估、起效时间和疗效持续时间无统计学意义（P＞0．05）,高浓度组出现不同程度上睑下垂16例,低浓度组出现2例,差异有统计学意义（P＜0．01）。两组均未出现中毒和药物过敏症状,上睑下垂发生后通常在3～6 wk内逐渐恢复,严重可以给予盐酸奈甲唑林点眼缓解。结论：两种不同浓度的BTX－A局部注射治疗眼睑痉挛的疗效是肯定的,鉴于对上睑下垂并发症的评估,推荐使用低浓度注射。     

A new refined technique for myogenic ptosis correction with resection of myotarsal flap by conjunctival approach

The purpose is to present a new refined surgical technique for mild-to-severe acquired myogenic ptosis correction under local anaesthesia (LA) as day cases with resection of myotarsal (MT) flap and demonstrate the safety and efficacy of the technique. MT flap consists of 2 mm tarsal strip with attached levator complex – levator muscle, its aponeurosis, and Müller muscle.

This is a retrospective personal series of 400+ patients, who underwent surgical correction with MT flap resection of 8–24 mm under LA mostly as day cases.

No patient had any complication. Results were satisfactory as assessed on these criteria: (i) elevation of the lid at least above the visual axis; (ii) normal contours of the lid without distortion, with the eyelid conforming to the contours of the globe; (iii) static and dynamic symmetry of upper eyelids; (iv) formation of a normal and symmetrical lid fold; (v) healthy comfortable ocular surface and cornea; and (vi) patient and surgeon satisfaction with the aesthetic outcome.

Resection of the MT flap is a safe and effective, microsurgical technique of ptosis correction, yielding satisfactory results without complications, with ergonomic advantages of the inclusion of a tarsal strip. The versatility of the MT flap extends to its use for correction of upper lid retraction, and for formation of the posterior lamina of full thickness small to subtotal lower lid reconstructions.     

Clinical trial to compare efficacy and side-effects of injection of posterior sub-Tenon triamcinolone versus orbital floor methylprednisolone in the management of posterior uveitis

AIM: To compare the efficacy and side-effects of posterior sub-Tenon injection of triamcinolone acetonide (Kenalog) with orbital floor injection of methylpredisolone acetate (Depomedrone) in the management of posterior uveitis. METHODS: Non-randomized comparative prospective clinical study. Sixty-four eyes from 60 consecutive patients with non-infectious posterior uveitis requiring treatment were allocated on an alternate 1:1 basis to receive either orbital floor methylprednisolone or sub-Tenon triamcinolone using standard procedures and assessed at 6 and 12 weeks. RESULTS: After five eyes of five patients who had received the same treatment bilaterally were excluded from the statistical analysis, 14 out of 29 eyes treated with orbital floor methylprednisolone and 10 out of the 30 eyes given sub-Tenon triamcinolone improved at 6 weeks. There was no statistically significant difference in the improvement rate between the two groups. However, two patients given triamcinolone had prolonged upper lid ptosis, which required surgery, and another two developed markedly raised intraocular pressure, neither of which occurred in the methylprednisolone-treated group. CONCLUSIONS: Although the two drugs and routes compared were of similar efficacy, lid ptosis occurred in the triamcinolone-treated but not the methylprednisolone group. This should be borne in mind when choosing the preferred route of delivery of periocular corticosteroid in the treatment of posterior uveitis.     

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.     

The psychological well-being and appearance concerns of patients presenting with ptosis

Purpose

Ptosis affects both the function and appearance of the eyes and face, because of drooping of the eyelids. Previous research has focused on functional impairment; however, similar appearance altering eye conditions have been demonstrated to have major impacts on psychosocial functioning.

Methods

This study examines the psychological well-being and appearance concerns of patients presenting with ptosis recruited from Bristol Eye Hospital using validated questionnaires focusing on demographics and psychosocial factors before surgery.

Results

Patients reported higher levels of anxiety, depression, and appearance concern than population norms, with scores comparable to previous research examining the impact of other disfiguring eye conditions. Gender differences were observed, with almost half of females experiencing significant psychosocial issues related to appearance concern about their ptosis compared with 20% of males. Linear regressions revealed that the main predictor of poor adjustment to the appearance of ptosis was the level of concern an individual had regarding the negative perceptions of other people. These results implicate psychosocial factors and demographics as predictors of the development of appearance-related distress and compromised psychological well-being for patients with ptosis who are currently seeking surgery.

Conclusions

This study provides clinicians with a greater understanding of the concerns of affected patients, and treatment motivations. The findings may also inform the development of patient reported outcome measures and support for patients, which targets the psychosocial impact of the condition.     

An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis

Purpose : To evaluate the safety and efficacy of botulinum toxin type A (BOTOX, Allergan) when used to produce a protective ptosis in patients where a surgical tarsorrhaphy would otherwise be required. Methods : A total of 21 patients entered into the study. Doses of 2.5 and 5.0 units of BOTOX were injected into the levator palpebrae superioris muscle through the eyelid. The patients were followed daily where practical until a ptosis developed and then monitored 1–2 weekly until the ptosis was resolved. Injections were repeated, if necessary, until the underlying condition had healed. Results : Ptosis took an average ± SE of 4.0 ± 0.5 days to develop (range 2–8 days). Duration of ptosis was an average ± SE of 46.0 ± 12.1 days (range 1–206 days). The effective dosage was 5 units of BOTOX in 0.1 mL. In 16 patients, the ptosis produced by BOTOX was sufficient to allow the underlying disease to heal and a surgical tarsorrhaphy was avoided. One patient required a surgical tarsorrhaphy and three patients required other surgical intervention to correct the underlying condition. One patient was lost to follow up. Diplopia was seen in five patients but resolved in all cases. Conclusions : BOTOX was a suitable alternative to a surgical tarsorrhaphy.