应用提上睑肌缩短术与额肌瓣悬吊术治疗先天性上睑下垂

目的 应用提上睑肌缩短术与额肌瓣悬吊术治疗先天性上睑下垂,依据睑下垂程度寻求最佳手术选择.方法 对47例不同程度的先天性上睑下垂患者进行了手术治疗,其中28例上睑提肌肌力在2 mm以上者选择了提上睑肌缩短术,其中28例上睑提肌肌力之间者选择了额肌瓣悬吊术;19例上睑提肌肌力在0 mm～2 mm之间者选择了额肌瓣悬吊术.结果 采用上睑肌缩短术28例,术后双眼对称者20例,6例患眼较健侧低1 mm,2例相差2 cm;采用额肌瓣悬吊术19例,术后双眼对称者12例,5例相差1 mm,2例相差2 mm.两种手术方法比较,适用提上睑肌缩短术的患者上睑皱襞弧度自然,美容效果明显.结论 额肌瓣悬吊术适用于上睑提肌肌力为2 mm以下的重度患者;上睑提肌肌力在2 mm以上的患者宜采用提上睑肌缩短术矫正,能达到提上睑功能和美容效果最大程度的恢复与改善.     

不对称双侧先天性上睑下垂的分期手术治疗策略

目的 探讨不对称的先天性双侧上睑下垂进行分期手术的治疗策略。方法 对2011年至2013年的30例不对称双侧上睑下垂患者进行分期手术矫正。一期手术矫正较重侧(中~重度),行睑板部分切除联合上睑提肌缩短前徙术;3~6个月后再行较轻侧矫正,行睑板部分切除术或上睑提肌缩短术。术后随访3~24个月,术后评估内容包括矫正程度与双侧对称性。结果 全部30例患者60只眼,在矫正效果评估中,37(61.7%)只眼为充分矫正,23(38.3%)只眼为中等矫正,无矫正不足或过矫病例。对称性评估中,23(76.5%)例达到良好对称,7(23.5%)例达到中等对称,无对称不佳病例。结论 与我们以往的治疗经验相比,对于不对称的双侧先天性上睑下垂,分期手术治疗能够达到更好的对称效果。     

先天性无眼球症的整形治疗

目的 探讨先天性无眼球症的整形治疗方法。方法 手术分二期进行，一期行骨性眶窝扩大的全眼窝再造术与耳软骨移植睑板再造术，二期行上睑提肌缩短或额肌瓣悬吊的上睑下垂矫正术。结果 5例手术均获成功，效果满意。结论 骨性眶窝扩大与睑板再造后上睑下垂矫正可获得较好的义眼植入与睁眼效果。     

Physiological correction of mild to moderate congenital blepharoptosis: A retrospective cohort study involving 97 Eastern Asian patients

BackgroundConventional blepharoptosis repair methods distort the normal anatomy of levator aponeurosis and often cause a visible depressed scar in the upper eyelid.MethodsThe levator aponeurosis was dissected as a flap from the pretarsal tissue in mono-eyelid Asian patients who had mild to moderate congenital blepharoptosis. The flap base was advanced and repositioned on the tarsus. The margin of the distal flap was interposed and fused with orbicularis oculi muscles. Postoperative evaluation included ptosis correction, symmetry, and overall cosmetic outcomes.ResultsA total of 162 eyes on 97 patients were corrected using our method. Follow-up time ranged from 8 to 24 months (mean 12.4). In mild ptosis eyelids, out of 58 eyelids, 36.2% (21 eyelids), 56.9% (33), and 6.9% (4) required adequate correction, normal correction, and undercorrection, respectively, whereas in moderate ptosis, the results were 34.6% (36 eyelids), 53.9% (56), and 11.5% (12), respectively. For symmetry, 58.8% (57 cases), 32.0% (31), and 9.2% (9) resulted in good, fair, and poor outcomes, respectively. For cosmetic outcomes, 82.8% (48 eyelids), 15.5% (9), and 1.7% (1) of mild ptosis cases achieved good, moderate, and poor results in mild ptosis cases, whereas the results were 77.9% (81 eyes), 20.2% (21), and 1.9% (2), respectively, in moderate ptosis cases. The only complication among all cases was postoperative swelling.ConclusionsWe presented a new blepharoplasty for ptosis repair that allows both satisfactory ptosis correction and cosmetic outcomes in mild to moderate congenital blepharoptosis.     

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。     

应用不同术式矫正先天性上睑下垂的疗效比较

目的比较应用上睑提肌缩短术和额肌筋膜瓣悬吊术矫正中、重度先天性上睑下垂的修复效果。方法应用上睑提肌缩短术、额肌筋膜瓣悬吊术修复先天性上睑下垂患者16例（27侧）。结果上睑提肌缩短术修复16侧，术后外形自然，兔限恢复时间短，几乎没有睑球分离发生，手术时间短，创伤小。额肌筋膜悬吊术修复11侧，术后外形欠自然，兔眼消失时间长，且常有睑球分离，手术时间相对较长，剥离范围及创伤也较上睑提肌缩短术更大，术后恢复时间长。结论上睑提肌缩短术是利用患者原有上睑提肌的力量；额肌筋膜瓣是借用额肌的力量，作用方向与上睑提肌略有不同。故上睑提肌缩短术更符合生理要求，手术效果较好。     

上睑提肌缩短联合睑板部分切除矫正重度先天性上睑下垂效果观察

目的:探讨上睑提肌缩短联合睑板部分切除术矫正重度上睑下垂的疗效。方法:对重度先天性上睑下垂44例49眼进行手术治疗,其中行上睑提肌缩短联合睑板部分切除术共24例26眼,额肌瓣悬吊术20例23眼,术后对上睑缘位置、上睑的弧度形态、眼睑闭合度及并发症情况进行随访,并据此评价手术疗效。结果:术后随访3~24个月,行上睑提肌缩短联合睑板部分切除术后上睑下垂矫正较满意,术后形态较好,并发症发生率低,明显优于额肌瓣悬吊术患者,二者差异有统计学意义(P0.05)。结论:上睑提肌缩短联合睑板部分切除术,符合眼睛的正常生理结构,术后并发症少,疗效满意。     

联合筋膜鞘+提上睑肌复合瓣悬吊矫治先天性重度上睑下垂

目的:探讨联合筋膜鞘+提上睑肌复合瓣悬吊治疗先天性重度上睑下垂的临床效果。方法:选取2017年9月至2019年3月于河北省眼科医院住院的先天性重度上睑下垂患者205例248眼,随机分为三组,分别应用联合筋膜鞘+提上睑肌复合瓣悬吊术(CFS+L复合瓣悬吊组)、联合筋膜鞘悬吊术(单纯CFS悬吊组)、额肌瓣悬吊术(额肌瓣悬吊组)加以矫正;随访6个月,比较三组患者正矫率、上睑回退率、上睑活动范围及眼睑闭合不全情况、并发症发生率和患者满意度。结果:CFS+L复合瓣悬吊组较其他两组有更高的正矫率,CFS+L复合瓣悬吊组及单纯CFS悬吊组术后较额肌瓣悬吊组有更好的上睑活动度、眼睑闭合不全状态较轻、并发症发生率较低,患者满意度较高;CFS+L复合瓣悬吊组较单纯CFS悬吊组术后上睑回退率低、具有更好的稳定性;差异均有统计学意义(P<0.05)。结论:联合筋膜鞘+提上睑肌复合瓣悬吊术矫正先天性重度上睑下垂具有治愈率高、效果更加稳定的特点,是一种符合眼睑活动生理学特点的动态术式。     

Modified technique and ptosis clamp for surgical correction of congenital pediatric ptosis by anterior levator resection

Congenital ptosis is due to a dysgenesis of the levator complex with the levator muscle being replaced by fatty and fibrous tissue. This dysfunction of the levator muscle gives rise to the classic triad of findings in congenital ptosis, including ptosis in the primary position, lagophthalmos in downgaze, and a poorly formed eyelid crease. There are traditionally two ways to surgically correct congenital ptosis, levator resection and frontalis suspension (by utilizing a myriad of both autogenous and synthetic materials). Although frontalis suspension is the more utilized surgical option for the correction of congenital ptosis, the complication rate due to the use of synthetic materials is not insignificant. Many surgeons feel that the contour and appearance of the eyelid following levator resection is superior to the frontalis suspension technique. Thus, levator resection for congenital ptosis can be one of the most satisfactory and physiologically normal of the ptosis procedures. Surgery for congenital ptosis can however be unpredictable in outcome. We propose a modified technique for levator resection as well as a newly designed and modified Berke ptosis clamp for levator resection surgery. Postoperative results with the modified technique as well as clamp have been very encouraging with excellent postoperative lid contour and height. The author has utilized this clamp and modified technique in over 350 lid surgeries over the past ten years.     

Super-maximum levator resection for severe unilateral congenital blepharoptosis

The treatment for severe unilateral blepharoptosis is controversial. Sixteen consecutive cases of severe unilateral blepharoptosis were studied: eight had a super-maximum levator muscle resection (30 mm or more) and eight had a bilateral brow suspension with excision of the normal levator. Cosmetically acceptable results were achieved in six of eight cases undergoing a super maximum levator resection. Disparity in the palpebral fissure in downgaze ranged from 3 to 6 mm and was not bothersome to either patient or parent. Postoperative complications such as hypotropia and conjunctival prolapse can be minimized with careful technique. Four to eight cases undergoing bilateral brow suspension with excision of the normal levator had residual ptosis. Brow scars were occasionally noticeable. Overall cosmesis was considered better in the super-maximum levator resection group compared to the frontalis sling group by unbiased observers. Super-maximum levator resection is a good alternative in the treatment of severe unilateral blepharoptosis for selected cases, particularly for those who fear manipulation of the normal eyelid.     

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。     

A Modified Technique Combining Excision of the Levator Muscle and Tarsus for Blepharoptosis in Asians: A 6-Year Experience with 116 Cases

Background  

In patients with blepharoptosis, the function of levator muscle is insufficient or completely absent, causing blepharoptosis in various degrees. For mild or moderate blepharoptosis, levator advancement or resection is commonly performed. However, in severe cases, undercorrection results and recurrence often occur even a great length of levator muscle is resected. Because the levator muscle makes the upper eyelid move in a physiologic direction, exerting the function of residual levator muscle is still a more preferred approach for correction of blepharoptosis. This study combined tarsus resection with levator resection. The resected tarsus can offset the amount of the levator excised, making this technique applicable for severe cases.     

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.     

Tarsal resection operation in correction of severe unilateral blepharoptosis with poor levator function

There are many options for surgical repair of congenital unilateral ptosis with poor levator function. We performed resection of tarsus, Müller muscle, and conjunctiva in conjunction with an intraoperative adjustable levator resection. Resection of tarsus, Müller muscle, and conjunctiva in conjunction with levator resection was performed in a prospective series of 17 consecutive patients with unilateral ptosis with poor levator function over a 2-year period. Pre- and postoperative upper eyelid margin to reflex distance, degree of levator function, amount of operative tarsus and Müller muscle resection, postoperative eyelid symmetry, and postoperative complications were evaluated. Mean preoperative upper eyelid margin to reflex distance was 0.11 mm. Mean postoperative upper eyelid margin to reflex distance was 3.20 mm. Improved postoperative eyelid symmetry within 1.0 and 1.5 mm was demonstrated in most of our cases (58% and 76%, respectively). The major complication has been exposure keratitis. Resection of tarsus, Müller muscle, and conjunctiva combined with adjustable levator resection can correct severe unilateral ptosis with poor levator function.     

提上睑肌腱膜Müller’s肌瓣与额肌连接术治疗重度上睑下垂

报道采用提上睑肌腱膜的Ｍｌｌｅｒ’ｓ肌瓣与额肌连接术治疗重度上睑下垂２０例（２５只眼），经６个月～３年随访，满意率为６０％，基本满意２０％，有５只眼矫正不足，无过度矫正者。详细介绍了手术方法。讨论了手术原理、优缺点等。     

The Use of Polypropylene Suture as a Frontalis Suspension Material in All Age Groups of Ptosis Patients

ABSTRACT

Purpose/Aim: To evaluate the use of 2–0 polypropylene suture for frontal suspension in ptosis patients with poor levator function. Materials and Methods: This retrospective study included 20 eyelids of 16 patients (5 female, 11 male) with 4 mm or less levator function. The operation was considered successful when the difference between the two upper lids was ≤1 mm, and the upper lid covered the upper limbus by <3 mm. Results: Median patient age was 22.94 years (2 to 59). Mean follow-up time was 18.06 months (12–29). A successful result was obtained in 14 patients (87.5%). Ptosis recurrence was observed in two patients (12.5%). Lagophthalmos with punctate epithelial keratitis and subsequent spontaneous recovery occurred during the first postoperative week in six patients (37.5%). Two patients with hypocorrection underwent revision surgery in the first postoperative week. Granuloma and material exposition at the forehead incision site observed in one patient at the postoperative fifth month were repaired by excision of the granuloma and suture reposition. Conclusions: Polypropylene suture as a frontalis suspension material in ptosis patients with poor levator function maintained satisfactory results at follow-up. This material allows easy and repeatable eyelid height adjustment and does not obviate future eyelid procedures.     

The management of the ptosis patient: Part I

The various types of congenital and acquired ptosis are discussed as well as the findings on history and examination. From this information the appropriate operation can be chosen. Emphasis is placed on obtaining accurate and reproducible measurements in addition to assessing visual acuity, extraocular muscle movement, Bell's phenomenon, and tear secretion, especially in older patients. The operations described are the tarsal-Muller's muscle resection, levator aponeurosis advancement, levator resection, and frontalis suspension. Since the aim in ptosis surgery is symmetry in the primary position, overcorrections and undercorrections must occasionally be dealt with to achieve a satisfactory result.     

Transposition of the levator in blepharoptosis using a single superior lid crease incision

In 1999 we introduced the technique of transposition of the levator using a suture to the frontalis muscle for the correction of severe blepharoptosis [16, 17]. This operation was carried out using two skin incisions, one on the superior lid crease and the other at the superior margin of the eyebrow. It was later demonstrated that the levator muscle becomes reinnervated by the facial nerve branches to the frontalis muscle [18]. The results of this procedure have been satisfactory without infections or lagophthalmos [9, 19, 20]. The only limit of this technique is the ability of the patient to contract the frontalis muscle. This limitation, however, applies to any surgical technique which consists of suspension of the eyelid to the frontalis area. After having performed 22 levator transpositions, utilizing two skin incisions, the procedure is now performed with a single skin incision on the superior lid crease. With this modification the technique might be well accepted by those surgeons who deal with the problems of upper eyelid ptosis.     

部分睑板全层切除联合提上睑肌缩短术矫正中重度上睑下垂

目的:探讨部分睑板全层切除联合提上睑肌缩短术矫正中重度上睑下垂的方法和疗效。方法:对15例(2007年～2011年)(19只眼)中重度上睑下垂患者行部分睑板全层切除联合提上睑肌缩短术。结果:术后随访6个月～3年,本组15例(19只眼)中重度上睑下垂均矫正满意(外观满意,弧度自然)。早期均有不同程度的眼睑闭合不全的情况,一般术后1～3个月内完全恢复,无并发症发生。结论:部分睑板全层切除联合提上睑肌缩短术,此手术操作简单,并发症少,而且疗效确切。     

Treatment of congenital and acquired upper eyelid ptosis: report of 131 consecutive cases

In this paper, a 5-year experience in the management and surgical treatment of upper eyelid ptosis at the Plastic Surgery Institute of Milan University Medical School is presented. From September 1992 to April 1996 a total of 131 consecutive cases were treated surgically. The patients are grouped into three categories: those with good residual function of the levator muscle in which a levator resection procedure was performed; those with poor residual function in which a frontalis suspension was selected; and those with moderate residual function in which levator surgery was the initial treatment, followed by a second operation (frontalis suspension) in unsatisfactory results. At postoperative follow-up, 101 cases were rated good, 22 were fair, and nine were poor. Early and late complications are discussed, together with some important key-points in the management and surgical treatment of the patients. Received: 31 December 1999 / Accepted: 6 May 2000