小睑裂综合征的联合手术方法

目的探讨小睑裂综合征的联合手术方法。方法小睑裂综合征l3例26眼,采用三联手术,即上睑提肌缩短术、上睑提肌缩短加横韧带悬吊术、额肌腱膜悬吊术或额肌悬吊术治疗上睑下垂;Spaeth双“Z”成形术和“Y-V”成形术治疗内眦赘皮;并进行外眦开大术以扩大睑裂,3项手术一次完成。结果术后外观有明显改善,睑裂长度和高度显著增加,内眦间距显著缩短。术前睑裂长度19~24mm,平均(21.0±1.4)mm,睑裂高度:1~4mm,平均(2.3±1.1)mm,内眦间距35~40mm,平均(37.0±1.6)mm,术后睑裂长度25~30mm,平均(27.4±1.3)mm。睑裂高度:5~8mm,平均(6.2±0.9)mm。内眦间距30~35mm,平均(32.7±1.3)mm,各相应组两两比较差异均有统计学意义(P=0.000)。结论三联手术治疗小睑裂综合征取得良好效果。     

改良Y-V成形及额肌瓣悬吊治疗小睑裂综合征

目的 探讨小睑裂综合征的临床特点及手术效果。方法 回顾性分析我院2002年3月至2006年7月间收治的小睑裂综合征15例。结果术后随访3～36个月,Y-V成形及额肌瓣悬吊Ⅰ期手术治疗的15例患者,术后睑裂长度平均增长3～5mm;睑裂宽度增大3～6mm;双眼内眦间距缩短7～12mm。结论 改良Y-V成形及额肌瓣悬吊Ⅰ期手术治疗小睑裂综合征患者效果肯定。小睑裂综合征患者应尽早手术治疗。     

上睑提肌-额肌吻合联合L形内眦成形术治疗轻度小睑裂综合征

目的 探讨一期采用上睑提肌-额肌吻合联合L形内眦成形术治疗轻度小睑裂综合征的临床疗效.方法 回顾性分析采用上睑提肌-额肌瓣吻合联合L形内眦成形术治疗轻度小睑裂综合征患者22例44只眼,术后随访6～12月(平均10月).结果 术后所有患者的重度上睑下垂、逆向内眦赘皮、下睑内翻均得到矫正,术后睑裂长度和内眦间距较术前明显改善,内眦部无明显瘢痕形成,眼部外观满意,未发生睑内翻及暴露性角膜炎等并发症.结论 上睑提肌-额肌吻合联合L形内眦成形术治疗轻度小睑裂综合征手术简单经济、疗效确切,值得临床推广.     

先天性眼睑综合征的整形手术

目的探讨先天性眼睑综合征的整形疗效。方法对21例2～14岁患儿,一期应用改良的Y－V矫正法及部分行外眦开大术,矫正内眦赘皮内眦宽距及小睑裂。二期应用额肌瓣悬吊术矫正上睑下垂。结果随访3月～3年,睑裂长由术前的20．75±1．75mm达到术后的27．25±0.75mm,内眦间距由术前的44．5±4．5mm缩短到术后的34．5±2．5mm,睑裂高度≥6mm,上睑下垂矫正,外观满意。结论对先天性眼睑综合征应用此分期手术方法,术式简单,整形效果满意。     

改良Mustarde术矫正小睑裂综合征临床观察

2001年1月至2001年6月本院用改良Mustarde内眦成形术、额肌瓣悬吊术及外眦开大术等多种术式联合矫治小睑裂综合征4例,取得满意疗效,现将手术方法报告如下。     

介绍一种治疗先天性睑烈狭小缝合征的手术(摘要)

先天性睑裂狭小综合征Blepharophimosis Syndrome是一种常染色体显性遗传病,临床上有四大特征;先天性上睑下垂、倒向性内眦赘皮、睑裂缩小及两眼内眦距离增宽。我院于90年2月采用日本内田氏手术矫治一例,效果良好。患者女,13岁,自出生即发现双眼上睑下垂。检查:双眼内眦赘皮,上睑下垂,上睑缘遮盖瞳孔约1mm,去除额肌作用后,双上睑均无提上睑运动,双睑裂水平径22mm,垂直径4mm,双眼内眦距离41mm。诊断:双眼睑裂狭小综合征。手术方法:将国外二期手术改为一期手术。即内田氏内外眦成形术与上睑下垂阔筋膜悬吊术同时进行。(1)内眦部手     

手术矫治小睑裂综合征

1994年 3月至 1999年 4月 ,我院采用改良的Ｙ Ｖ内眦成形术、额肌瓣悬吊术及外眦开大术等多种术式联合矫治小睑裂综合征 2 1例 ,取得满意疗效 ,现将手术方法报告如下。1 资料和方法 :(1)对象 :收集本院小睑裂综合征患者2 1例 (42只眼 ) ,其中男性 15例 ,女性 6例 ;年龄 4～ 16岁 ,平均 8岁。 5例男性患者有 2代家族遗传病史。 2 1例均有典型的双上睑下垂、内眦赘皮、小睑裂及内眦间距增宽四联征 ,部分伴有鼻背低平。平均内眦间距、睑裂宽度及睑裂长度分别为 (39 94± 1 76 )、(2 92± 1 5 5 )及 (18 96± 1 5 4 )ｍｍ。全部病例滴用 1%阿托…     

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。     

儿童重度先天性上睑下垂的手术治疗

目的:探讨涤纶网织带额肌悬吊术对儿童重度先天性上睑下垂的手术治疗效果。方法:对55例74眼儿童重度先天性上睑下垂进行涤纶网织带额肌悬吊术,术后随访时间1～24(平均6.5)mo。术前术后及随访拍摄照片对照。结果:术后达正矫69眼(93%);低矫5眼(7%);无过矫发生。结论:涤纶网织带额肌悬吊术治疗儿童重度先天性上睑下垂是一种安全有效的手术方法。     

先天性小睑裂综合征临床手术疗效分析

目的探讨先天性小睑裂综合征的手术治疗效果。方法回顾性分析先天性小睑裂综合征患儿23例（46眼），年龄2～11岁，均伴有其他眼疾或全身疾病。所有患儿同期行双眼内眦赘皮矫正＋额肌腱膜悬吊术。内眦赘皮矫正采用的术式有4种，其中Y—V成形术2例、Stallars“Z”成形术7例、Speath术式5例及经典的Mastands内眦成形术9例。上睑下垂矫正采用额肌腱膜悬吊术。术后随访1～24个月，观察睑裂长度、睑裂高度、内眦间距及眉睑距等参数变化。术后1、6、18个月分别检查三棱镜斜视度。采用配对t检验对手术前后患者的睑裂长度、睑裂高度、内眦间距及眉睑距等进行比较。结果23例患儿均顺利完成手术。术后睑裂长度及高度均有明显提高，内眦间距及眉睑距明显缩小。术后1个月，睑裂长度由术前的（18．5±1．1）mm增长至（23．4±1．2）mm，睑裂高度由术前的（2．1±1．2）mm增高至（6．7±0．9）mm，内眦间距由术前的（3512±1．4）mm减小至（31．1±1．1）mm，眉睑距由术前的（13．6±1.3）mm减小至（9．8±1．2）mm，与术前比较，差异均有统计学意义（t分别为4．985、10．832、2．143和4．171，P均〈0．05）。术后1个月，仅见暴露性角膜炎1例，未见其他并发症。术后6、18个月的随访数据与术后1个月比较，差异均无统计学意义（P〉0．05），表明手术疗效在术后1个月时保持稳定。结论对于先天性小脸裂综合征，早期双跟周期行内眦赘皮矫正联合额肌腱膜悬吊术是比较理想的治疗手段．     

先天性小睑裂综合症的临床特征与手术治疗

目的 探讨先天性小睑裂综合症的临床特征与手术治疗。方法 对16例小睑裂患者,Ⅰ期行内眦成形术或内外眦成 形术,Ⅱ期行上睑下垂矫正术。术后随访1月-2年。结果 经对术前和随访时结果的比较,证实可达到开大睑裂和充分上提 上睑的目的。结论 分二期手术治疗先天性小睑裂综合症,效果满意。     

Transconjunctival frontalis suspension: a clinical evaluation.

PURPOSE: To determine the effectiveness of transconjunctival frontalis suspension in patients with blepharoptosis and poor levator function (eyelid excursion less then 5 mm). METHODS: The medical records of 29 patients (50 ptotic eyelids) were reviewed. RESULTS: Four patients (eight eyelids) had blepharophimosis syndrome, ten patients (27 eyelids) had congenital ptosis, seven patients (14 eyelids) had myogenic ptosis, and one patient (one eyelid) had neurogenic ptosis. Surgical results were good and complications were minimal during follow-up intervals ranging from six months to seven years. CONCLUSIONS: Transconjunctival frontalis suspension is technically simpler than traditional external frontalis suspension and yields satisfactory functional and cosmetic results in patients with poor levator function.     

One-stage correction for blepharophimosis syndrome

PURPOSE: To classify the severity of blepharophimosis, describe associated features and their effects on the incidence of amblyopia and to recommend guidelines for surgical treatment and management of surgical complications.METHODS: The case records of 23 patients with blepharophimosis syndrome were examined retrospectively. Patients' photographs and measurements were reviewed to analyse the severity of blepharophimosis, surgical techniques undertaken, surgical outcomes, and complications. Statistical analyses were performed using paired-sample t-tests to evaluate the surgical outcome and Spearman correlation to examine the influence of blepharophimosis on the interpalpebral fissure height (PFH).RESULTS: Eighteen out of 23 (78%) patients underwent one-stage surgery before the age of 5 years. About 31% of these patients had amblyopia. Only two patients had a blepharophimosis ratio greater than 1.5 as poor result. Two out of 18 (11%) patients with PFHs more than 2 mm needed a repeat operation, but all five (100%) patients with s less than 2 mm (very severe ptosis) needed repeat operations.CONCLUSIONS: The one-stage corrective procedure provided acceptable results both in function and cosmesis. However, patients with very severe ptosis required multiple stages of reconstruction for ptosis correction at an earlier age, after which correction of telecanthus and small horizontal palpebral fissure length followed at an older age.     

学龄前儿童额肌瓣悬吊术后角膜损伤的相关问题研究

目的:探讨学龄前儿童先天性上睑下垂额肌瓣悬吊术后角膜损伤发生的原因及预防措施。方法:先天性上睑下垂患儿94例108眼采用额肌瓣悬吊术矫正上睑下垂,观察治疗前、后的Bell氏现象、上睑睫毛方向,瞬目次数,睑裂闭合不全情况,常规裂隙灯检查角膜荧光素染色、泪膜破裂时间的变化,对结果进行统计学分析。结果:术后1wk角膜损伤的发生率为10.2%,术后2wk所有患儿的角膜损伤都基本痊愈。术后早期角膜荧光素染色、瞬目次数及BUT与术前相比有显著统计学差异,术后2wk与术前相比无明显改变。结论:额肌瓣悬吊术矫正学龄前儿童先天性上睑下垂是一种比较安全、有效的手术方式,术后角膜损伤的发生主要与睑裂闭合不全、倒睫、瞬目减少、Bell氏现象消失以及泪膜不稳定有关。     

先天性小眼球及隐眼的眼窝畸形矫治

目的探讨先天性小眼球及隐眼眼窝畸形的最佳矫治时机与矫治方法。方法回顾性分析我院收治的14例（14眼）先天性小眼球（其中2例为隐眼）病例的临床表现、就诊时间、矫治方法及治疗效果。结果14例中的12例行小眼球摘除联合义眼座植入术,9例因小睑裂、小眼眶,同时行内、外眦延长成形术,并选用了最小号（直径18mm）的义眼座;其中3例外侧眶缘截骨术,2例术中将义眼台进行了磨削,实际直径为16～17mm。12例术后均眶腔饱满,眼睑可自然睁开和闭合,配戴义眼片后,术眼活动与健眼同步,外观逼真,达到了满意的美学效果。随访6月～6年,平均23．5个月,无感染、眼座暴露或上眶区凹陷等并发症。其余2例结膜瓣遮盖后,配戴义眼片,因眼眶发育较好,美容效果也较理想。结论由于眼眶发育与眼眶的张力即眼球的直径直接相关,且有年龄阶段性。我们认为对眼球最大直径小于10mm的小眼球宜尽早选用相对稍大的羟基磷灰石义眼座矫治眼窝畸形;对最大直径大于10mm的小眼球患者,可先配戴义眼片并不断更换较大的义眼片,到8岁以后再酌情为他们施行义眼座植入手术;对小眼球角膜直径大于7mm,眼眶、结膜囊发育接近健眼,可保留眼球,仅以定制义眼片矫治眼窝凹陷。     

A sibship with unusual anomalies of the eye and skeleton (Michels' syndrome)

Four siblings of nonconsanguineous parents had congenital anomalies of the anterior segment of the eyes, eyelids, and skeletal systems. Anomalies of the anterior segment included opacities of the corneal stroma, conjunctival telangiectasia, and iridocorneal adhesions. Eyelid abnormalities included blepharoptosis, blepharophimosis, and telecanthus. One sibling with extensive anterior segment anomalies developed glaucoma. All subjects had impaired vertical gaze. Oromandibular anomalies varied from cleft lip and palate to malocclusion with overbite. Additional features included subnormal intelligence, short stature, hearing loss, and clinodactyly. This spectrum of anomalies appeared to have been transmitted as an autosomal recessive syndrome.     

Ocular findings in Treacher Collins syndrome

We examined 14 patients from nine families referred with the diagnosis of Treacher Collins syndrome. We noted seven significant ocular findings including the following: a subnormal horizontal palpebral fissure length and inferomedial displacement of the lateral canthus in primary gaze; further medial displacement (4.0 mm or more) of the lateral canthus with resultant shortening of the horizontal fissure length on forced eyelid closure (fissure narrowing sign); partial-thickness eyelid colobomata localized to the nasal one half to two thirds of the lower eyelids; bilateral absence of the inferior lacrimal puncta; bilateral blepharoptosis; inferior displacement of the palpebral fissures; and regular astigmatism without any consistent orientation of the axis of astigmatism relative to the lower eyelid defects, blepharoptosis, or lateral canthus. The fissure narrowing sign correlates with known anatomic deficiencies in the Treacher Collins syndrome and may prove valuable in confirming the diagnosis in patients who lack certain typical features.     

Main semeiologic characteristics of ptosis]

BACKGROUND: We report the main characteristics of blepharoptosis. MATERIALS AND METHODS: All cases of blepharoptosis treated at the Reims University Hospital from 1992 to 1997 were reviewed. Ptosis, levator function, palpebral aperture, and the position of the upper crease were recorded as well as results of the epinephrine test, acetylcholine esterase inhibitor antibodies and computed tomography findings. RESULTS: There were 96 unilateral and 34 cases of bilateral blepharoptosis (164 cases). The cases of congenital blepharoptosis (36 cases) were usually unilateral with severe ptosis and poor levator function. In cases with Claude Bernard Horner syndrome, the blepharoptosis was unilateral with minimal ptosis and a positive response to neosynephrine. In cases with oculomotor nerve palsy (31 cases) the ptosis was moderate to severe and levator function was poor. In those with myasthenia, the prostigmine test was positive. Levator aponeurotic disinsertion was observed in 16 cases with severe ptosis, positive response to neosynephrine and a high upper crease. There were three cases of trauma-induced ptosis, 5 cases of myopathy and 26 cases of idiopathic ptosis. DISCUSSION: The clinical presentation of blepharoptosis is usually related to the etiology. Bilateral blepharoptosis is most often observed in congenital forms, levator disinsertion or idiopathic cases. Male sex predominates in congenital ptosis and oculomotor palsy, and female sex in Claude Bernard Horner syndrome. Moderate to severe ptosis is observed in congenital ptosis or oculomotor palsy. The upper crease is absent in many cases of congenital blepharoptosis and is high in case of levator disinsertion. The response to neosynephrine is positive in Claude Bernard Horner syndrome and aponeurotic disinsertion. The response to prostigmine is positive in case of myasthenia. CONCLUSIONS: Clinical aspects of blepharoptosis are related to etiology. The different features guide surgical or medical treatment of blepharoptosis.     

Orbitoblepharophimosis syndrome--own clinical experience in treatment of 60 patients

PURPOSE: The orbitoblepharophimosis syndrome is an autosomal-dominant congenital malformation involving the orbitopalpebral region. The condition is associated with orbital phimosis, upper eyelid ptosis, epicanthus and telecanthus. MATERIAL AND METHODS: We retrospectively reviewed the records of 60 patients with blepharophimosis who underwent surgery in the Hospital of Plastic Surgery in Polanica Zdrój from January 1975 to January 2006. The study population consisted of 23 (38.3%) females and 37 (61.7%) males patients whose age at the time of first surgical stage ranged from 1 to 48 years (mean 8 years). Surgical management consisted of epicanthus correction using modified technique of Mustardé followed by eyelid suspension to the frontalis muscle with using temporal fascia. In patients with orbitoblepharophimosis type II, correction of the lower lid ectropion and antimongoid slanting palpebral fissures, were performed before or after Mustardé procedure. RESULTS: In our series of 60 patients, good result of treatment was obtained in 80.1% and satisfactory in 18.3% of patients. Poor outcome was obtained only in one patient with orbitoblepharophimosis type II. CONCLUSIONS: Orbitoblepharophimosis management should consists of gradual and complex surgical treatment. During the first stage epicanthus correction is performed. As a second stage, blepharoptosis is treated by frontalis suspension technique with using temporal fascia.