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。     

提上睑肌腱膜折叠矫正轻中度上睑下垂

目的探讨采用提上睑肌腱膜折叠矫正轻中度上睑下垂的临床效果。方法对先天性上睑下垂126例(177只眼)患者采用局部麻醉,行重睑术切口,适度分离切口下唇眼轮匝肌后,显露睑板上缘,沿眶隔后壁分离并确定提上睑肌腱膜后,行折叠,并固定于睑板上缘,调整双眼至对称后缝合皮肤。结果本组共126例(177只眼)患者,术后随访3~18个月。128只眼为满意(睑缘弧度符合生理性,术眼上睑缘遮盖角膜上缘≤2 mm,双眼基本对称);38只眼为基本满意(术眼上睑缘遮盖角膜上缘2~3 mm);8只眼为矫正不足(角膜上缘遮蔽3 mm);3只眼为过度矫正。结论采用提上睑腱膜折叠矫正方法治疗轻、中度上睑下垂,具有损伤小、容易操作、术后重睑自然等优点,值得在临床上推广应用。     

单切口额肌上睑SMAS瓣经眶隔后悬吊治疗上睑下垂

目的 总结单切口额肌上睑SMAS瓣经眶隔后悬吊治疗上睑下垂的适应证及手术方法.方法 取上睑重睑皱襞切口,SIFSF悬吊治疗上睑下垂,重建上睑提升动力通道近似上睑提肌滑行路径.自1993年7月至2009年11月,收治上睑下垂148例(215只眼),其中应用SIFSF经眼轮匝肌和眶隔后隧道悬吊治疗上睑下垂者81例(121只眼),包括严重或复发性上睑下垂、Horner′s 综合征、张口瞬目综合征、先天性睑裂狭小综合征和下颌面发育不良综合征伴有的上睑下垂等;应用上睑提肌腱膜缩短,提上睑肌粘连松解,节制韧带松解,睑板部分切除治疗上睑下垂67例(94只眼).结果术后早期发生睑内翻、角膜刺激者1 例,再次手术治愈;角膜溃疡者1例,经治疗好转;结膜脱垂者2例,术后血肿者2例,经保守治疗痊愈.在SIFSF悬吊治疗上睑下垂的81例(121只眼)患者中,术后经4周至10年随访者49例(69只眼),其中优良者30例( 45只眼),良好者17例(22只眼),矫正不足者2例(3只眼),矫正优良率为97%.术后提上睑功能和形态良好.矫正不足2例,经再次手术治愈.结论 单切口额肌上睑SMAS瓣经眶隔后悬吊治疗上睑下垂术式,可避免眉下切口,是一项符合上睑提肌生理功能的重建,适应证范围较广,手术操作简易,术后提上睑功能和上睑形态改善良好的手术方法.     

改良上睑提肌缩短术治疗中度和重度上睑下垂

目的 探讨应用改良上睑提肌缩短术治疗中、重度先天性上睑下垂的疗效.方法 对30例中、重度先天性上睑下垂患者(包括2例上睑下垂术后欠矫和复发患者),采用联合睑板切除的上睑提肌缩短术.术中睑板切除量根据睑板的宽度设计,上睑提肌切除量＝(上提量-睑板切除宽度)× (4～5) mm.并分离睑结膜和上睑提肌,切除一定量的睑结膜以防止结膜脱垂,对术后效果进行随访观察.结果 30例除3例矫正不足外,余均获得良好上提效果,上睑缘弧度自然,无严重并发症,仅少数患者早期有轻度睑裂闭合不全.结论 改良上睑提肌缩短术适用于中、重度先天性上睑下垂患者及上睑下垂术后欠矫的患者,在矫正畸形和改善外观方面均能达到良好的效果.掌握手术操作要点,有助于在功能和外形上取得满意效果.     

两种方法矫正先天性上睑下垂的效果观察

目的:探讨额肌悬吊术与提上睑肌缩短术矫正先天性上睑下垂的临床疗效.方法:对15例(20只眼)上睑下垂患者采用额肌悬吊术.对20例(25只眼)上睑下垂患者采用提上睑肌缩短术矫正.结果:前一种方法术后早期眼睑高度、弧度及重睑形成尚可,但欠自然,闭睑不全明显,持久性欠佳.后一种方法术后眼睑高度、弧度及重睑形成良好,美观自然,持久性好.结论:提上睑肌缩短术是矫治先天性上睑下垂的理想选择.     

先天性上眼下垂单睑成形矫正术89例临床分析

目的:采用提上睑肌缩短术治疗先天性上睑下垂,并对手术效果进行观察.方法:2004年9月至2011年4月,收治先天性上睑下垂患者89例(101只眼),其中重度上睑下垂14例(17只眼),中度上睑下垂43例(49只眼),轻度上睑下垂32例(35只眼),均行提上睑肌缩短术.结果:术后满意度93.5%以,好转度5.1%,总有效率97.9%.手术后出现的并发症有矫正不足、过矫、眼睑下垂复发等,经二次矫正治疗后均得到改善.结论:采用单睑成形矫正术治疗先天性上眼下垂具有确切疗效,术后眼睑功能正常,外形美观,疗效十分理想.     

提上睑肌与额筋膜瓣联合术治疗重度上睑下垂(附22例报告)

对重度上睑下垂,一般倾向于用额肌筋膜瓣悬吊术矫正,但单纯用此手术易发生睑缘成角畸形、上睑外翻、睑裂闭合不全等并发症,且操作不易掌握,额肌剥离范围大等缺点。我们采用提上睑肌和额筋膜瓣联合术,同时利用了两条肌肉将上睑上提,且保持提上睑肌完整性,避免了上述并发症,手术效果满意,报告如下。一、临床床资科本组22例、28只眼。男,15例,18只眼。女,7例,10只眼。年龄5～26岁,单侧者16例,双侧者6例,其中21例为先天性重度上睑下垂,1例为提上睑肌缩短术失败者。全部病历提上睑肌肌力均在4ｍｍ以下。术后随访14个月,27只眼均得到矫正,自然平视…     

提上睑肌缩短术矫正重度先天性上睑下垂效果观察

目的:现察提上睑肌缩短术矫正重度先天性上睑下垂的效果.方法:采用提上睑肌缩短术矫正量度先天性上睑下垂62例87眼.结果:本组病例中,完全矫正65眼(74.7%),基本矫正18眼(20.7%),复发4眼(4.6%).无过矫病例.结论:采用提上睑肌缩短术矫正重度上睑下垂,可取得良好的手术效果.     

联合筋膜鞘悬吊术协同提上睑肌缩短术治疗先天性重度上睑下垂

目的:探讨应用联合筋膜鞘悬吊术结合提上睑肌缩短术矫正先天性重度上睑下垂的临床疗效。方法:2016年12月-2018年12月笔者医院治疗先天性重度上睑下垂患者28例36眼,采用联合筋膜鞘悬吊术结合提上睑肌缩短术予以矫正。术后随访6~12个月。将患者术前、术后上睑缘中点到角膜反光点的距离(Marginal reflex distance,MRD)以及不良反应作为评价指标,评价其疗效。结果:本组28例患者36只患眼,治愈32只患眼(88.9%),改善3只患眼(8.3%),无效1只眼(2.8%)。均无严重并发症发生。结论:应用联合筋膜鞘悬吊术结合提上睑肌缩短术矫正先天性重度上睑下垂,手术操作安全、临床效果确切,值得临床推广应用。     

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。     

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。     

Treatment strategy for severe blepharoptosis

ObjectiveTo establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve improved accuracy and more stable correction outcome.MethodsThe levator muscle function was evaluated pre-operation. When the levator function was less than 1 mm, the frontalis suspension technique was performed; when the levator function was more than 1 mm, the techniques of levator resection, combined excision of the tarsus and levator, and tarsus–levator–CFS suspension were performed sequentially until a satisfactory correction result was achieved.ResultsA total of 389 patients with severe ptosis (561 eyes) were included; 102 eyes received levator resection, 314 eyes received combined excision of the tarsus and levator, 53 eyes received tarsus–levator–CFS suspension, and 92 eyes received frontalis suspension. In total, a satisfactory correction result was achieved in 466 eyes, while 95 cases still presented with under-correction. The symmetry findings showed that 107 (27%) cases presented good symmetry, 203 (52%) cases presented moderate symmetry, and 79 (21%) showed poor symmetry.ConclusionThis new treatment protocol overcomes the drawbacks of the traditional strategy by standardizing the correction procedure, leading to improved accuracy and more stable correction results.     

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。     

翼状韧带悬吊矫正先天性重度上睑下垂

目的 探讨翼状韧带悬吊矫正重度先天性上睑下垂的临床效果.方法 2010年1～11月,应用翼状韧带悬吊法治疗先天性重度上睑下垂患者15例15只眼,按照切开重睑术术式,打开眶隔,在距睑板上缘5 mm处剪断上睑提肌腱膜进入到上睑提肌下层,向结膜上穹窿分离,在上直肌前1/3和上睑提肌之间找到翼状韧带,用3-0丝线同上睑提肌缝合于睑板上缘,悬吊矫正上睑下垂,缝合形成重睑.结果 经过3～11个月随访,15只眼矫正良好,眼裂均在15～30 d基本闭合,无其他并发症发生,重睑弧度形态自然,外观满意.结论 翼状韧带悬吊治疗重度先天性上睑下垂疗效可靠,用翼状韧带代替上睑提肌,生理运动方向一致,术后眼睑外形动态与静态均较自然.

Abstract：

Objective To evaluate the clinical result of check ligament suspension for correction of congenital severe blepharoptosis. Methods Since Jan. 2010 to Nov. 2010, 15 eyes in 15 cases with congenital severe blepharoptosis were treated with the check ligament suspension. Palpebralis aponeurosis was exposured by opening fascia palpebralis during blepharoplasty. Palpebralis aponeurosis was cut off about 5 mm above the tarsus. The check ligament was seen in the intermuscular space between the segment of levator and the anterior one third of superior rectus attached to the conjunctival fornix. Congenital blepharoptosis could be corrected by suturing the check ligament and levator palpebrae superior to the upper margin of tarsal plate with 3-0 silk thread. Double eyelid plasty was carried out in the end. Results The follow-up period was 3-11 months with good cosmetic result. All the cases could close their eyes in 15 to 30 days with no complication. Conclusions In conclusion, this technique is quite successful in raising the level of the upper eyelid in severe congenital blepharoptosis. The check ligament moves in a similar direction as the natural movement of levator muscle, so both the postoperative static and dynamic appearance of the upper lid is more natural.     

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.     

眶隔筋膜瓣与额肌瓣重叠吻合悬吊矫正重度上睑下垂

目的:为更好地保持眼睑的原有结构,符合其生理和生物力学特点,探索一种治疗重度上睑下垂的新方法。方法:术中于眼轮匝肌下分离并显露眶隔筋膜至近眶上缘处,在眶隔表面设计一蒂位于睑板上缘的梯形瓣,按设计线全层切开眶隔,形成眶隔筋膜瓣。在患侧眉上形成一额肌瓣,将两瓣相互重叠缝合固定,上提睑缘至角膜上缘处,起到悬吊上睑、矫正下垂畸形的作用。结果:作者利用该方法对22例26侧重度上睑下垂的眼睑进行了治疗,随访病人17例,19侧眼睑,其中16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,可达到正常睑缘的位置。睑缘弧度及重睑外形满意。3侧眼睑矫正不完全,经二次手术修复得以矫正。讨论:作者认为利用眶隔筋膜形成的组织瓣与额肌瓣重叠吻合悬吊缝合,保持了眼睑的原有结构,具有手术损伤轻,上睑悬吊牢固,不易复发,睑缘和重睑线弧度及外观满意,畸形矫正效果良好,优于传统的单纯额肌悬吊术和上睑提肌腱膜瓣悬吊的方法。     

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.     

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.