加强提上睑肌力量的手术方式治疗老年腱膜性上睑下垂

目的:观察和评价利用加强提上睑肌力量的手术方式治疗老年腱膜性上睑下垂的效果及可行性.方法:对明确诊断为老年腱膜性上睑下垂的患者,根据上睑下垂程度的不同,分别行提上睑肌缩短术或提上睑肌折叠术矫正,术中按拟定缩短或折叠量预置缝线固定于睑板上缘下2 mm,观察上睑缘与角膜缘的位置关系,并随时调整缩短或折叠量,使上睑缘位于角膜上缘下0.5～1 mm,上睑缘位置与弧度满意后结扎缝线.结果:本组对18例31眼明确诊断为老年腱膜性上睑下垂患者行提上睑肌缩短术或提上睑肌折叠术矫正,随访3 wk～18 mo,疗效确切.结论:采取加强提上睑肌力量的手术方式治疗老年腱膜性上睑下垂,达到了矫正上睑下垂的目的,具有实际临床应用价值.     

提上睑肌折叠术联合眼睑皮肤松弛矫正术治疗老年性上睑下垂

目的 探讨提上睑肌折叠术联合眼睑皮肤松弛矫正术治疗老年性上睑下垂的临床效果.方法 对21例42眼患者分别实施提上睑肌折叠术联合眼睑皮肤松弛矫正术,术中分离提上睑肌和节制韧带,并除去多余的皮肤及眶脂肪.结果 所有患者除1例失访外,均改善上睑下垂症状和达到了美容目的 ,无暴露性角膜炎等手术并发症.结论 提上睑肌折叠术联合眼睑皮肤松弛矫正术是一种理想的改善老年性上睑下垂患者视功能和容貌的手术方法.     

老年腱膜性上睑下垂手术治疗

目的探讨老年腱膜性上睑下垂的手术治疗方法，并评价其临床效果。方法对12例（21眼）老年腱膜性上睑下垂根据上睑下垂程度的不同，分别行上睑提肌腱膜折叠术或上睑提肌腱膜修复术。中度下垂6眼行上睑提肌腱膜折叠术，重度下垂15眼行上睑提肌腱膜修复术，术后随访3—12个月。结果20眼上睑缘位于角膜上缘下1．5—2．5mm，1眼上睑缘位于角膜上缘下4mm，所有病例上眶区凹陷明显改善，收到治疗和美容的双重效果。结论采取加强上睑提肌力量的手术方式治疗老年腱膜性上睑下垂，手术安全，效果好。     

复发性先天性上睑下垂的发病原因和疗效分析

目的:分析先天性上睑下垂复发的原因,指导再次手术方式的选择。方法:术前了解前次手术方式,分析失败原因,根据提上睑肌肌力结合病史确定再次手术方式。以提上睑肌肌力为依据,考虑前次手术的手术方式,对于提上睑肌肌力≤4mm者均采用额肌瓣悬吊术,对于提上睑肌肌力≥6mm者,均选择提上睑肌缩短术,对于提上睑肌肌力4～6mm之间者,若前次手术是利用额肌的手术,可行提上睑肌缩短术或额肌瓣悬吊术,我们采用了额肌瓣悬吊术。结果:患者26例30眼术眼睑缘弧度无畸形,双重睑自然,上睑缘位于上方角膜缘下1～2mm,或与健眼基本对称。结论:复发性先天性上睑下垂再次手术要根据提上睑肌肌力结合病史确定再次手术方式。     

改良式上睑提肌缩短术

目的：为先天性上睑下垂寻求简便的手术方法，以达到功能和美学的双重效果。方法：回顾性分析1994－1999年我院施行改良式上睑提肌缩短术治疗31例（33眼）先天性上睑下垂情况，手术方法的要点：利用中横韧带或上睑提肌腱膜悬吊矫正上睑下垂。结果：术后早期睑缘覆盖角膜缘1－3mm者达93．8％，上睑缘弧度及双重睑形成良好。双侧眼窝深度对称。术后仅部分病例早期有轻度闭合不全，结论：该术式在改善提睑功能方面与传统上睑提肌缩短术无差别，但手术方法简单，效果肯定，不影响眼部固有解剖关系，采用可调式缝线，不影响二次手术。     

提上瞼肌折叠聯合額肌吻合衍29例的臨床療效

目的 探讨改良的提上睑肌缩短术治疗上睑下垂的临床疗效。方法 选择29例(35眼)上睑下垂患者,采用提上睑肌折叠联合额肌吻合术。结果 30眼上睑下垂术後早期平视时上睑缘遮盖上方角膜1～2mm者25眼,睑裂为6～9mm为32眼(91.8％),术後平均随访10(6～18)月,上睑缘位置轻度回退,最大回退量不超过2mm,上睑弧度及双重睑形成良好,睡眠时眼睑闭合良好,瞬目运动较自然。结论 该术式在改善提睑功能和增强美容效果两方面对矫正上睑下垂有良好的长期效果。     

改良提上睑肌缩短术治疗重度先天性上睑下垂

目的 探讨重度先天性上睑下垂的手术方法。方法 对25例(32只眼)提上睑肌肌力为0～3mm的重度先天性上睑下垂患者行改良提上睑肌超常量缩短联合上横韧带徙前术。结果 32只眼术后上睑缘高度及弧度、重睑形成均良好。结论 改良提上睑肌超常量缩短术对矫正重度先天性上睑下垂效果良好。     

提上睑肌折叠术在治疗重度先天性上睑下垂中的应用

目的:探讨采用提上睑肌折叠术治疗重度先天性上睑下垂的效果及可行性。方法:对36例(46眼)提上睑肌肌力<4mm的重度先天性上睑下垂行提上睑肌折叠术。结果:本组36例(46眼),术后随访6mo~4a,治愈40眼,占87%,欠矫6眼,占13%。结论:提上睑肌折叠术治疗重度先天性上睑下垂是一种可靠有效的手术方法。     

提上睑肌腱膜折叠术治疗轻中度上睑下垂临床观察

目的探讨提上睑肌折叠术治疗轻中度上睑下垂的疗效。设计回顾性病例系列。研究对象30例（43眼）提上睑肌肌力达8mm以上的轻、中度上睑下垂患者。方法采用经皮肤人路的提上睑肌折叠术,无需分离提上睑肌,观察手术前后上睑睑缘位置的变化。主要指标第一眼位上睑睑缘位置。结果术后随访6个月～2年,平均13．1个月。30例（43眼）患者第一眼位上睑睑缘位于正常位置,3例（3眼）欠矫,1例（1眼）过矫,术后效果满意。结论提上睑肌腱膜折叠术适合于轻中度上睑下垂患者。（眼科．2070．79．716—77R）     

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。     

Levator Resection in the Management of Myopathic Ptosis

Purpose

To evaluate the results of levator resection in patients with myopathic ptosis.

Methods

The medical records of consecutive patients who underwent levator resection surgery performed for myopathic ptosis between October 2009 and March 2013 were reviewed. Indications for surgery were ptosis obscuring the visual axis and margin-reflex distance ≤2 mm. Surgical success was defined as clear pupillary axis when the patient voluntarily opened his eye and margin-reflex distance ≥3 mm. We analyzed the effect of levator function and Bell''s phenomenon on the rates of success and corneal complication.

Results

This series included six male and six female patients. Levator function was between 4 and 12 mm. We performed bilateral levator resection surgery in all patients. The mean follow-up time was 14.8 months (range, 6 to 36 months). No patient was overcorrected. Adequate lid elevation was achieved after the operation in 20 eyes. Ptosis recurred in three out of 20 eyes after adequate lid elevation was achieved. Our overall success rate was 70.8%. In three eyes with poor Bell''s phenomenon, corneal irritation and punctate epitheliopathy that required artificial eye drops and ointments developed in the early postoperative period, although symptoms resolved completely within 2 months of the resection surgery. No patients required levator recession or any other revision surgery for lagophthalmos or corneal exposure after levator resection.

Conclusions

Levator resection seems to be a safe and effective procedure in myopathic patients with moderate or good Bell''s phenomenon and levator function greater than 5 mm.     

A simplified technique of ptosis repair using a single adjustable suture

PURPOSE: To describe a simplified technique for ptosis repair using a single adjustable suture. DESIGN: Retrospective noncomparative series. PARTICIPANTS: Fifty-one cases of ptosis repair performed or supervised by the same surgeon between 1993 and 1995. INTERVENTION: The surgical approach consisted of using a single adjustable "hang-back" 5-0 silk suture for plication of the superior portion of the levator aponeurosis. Lid height was then reassessed within the first 4 postoperative days and permanently readjusted by fixating the adjustable suture. Excluded were patients with history of unstable ptosis as a result of systemic disease or congenital, mechanical, and traumatic ptosis resulting from a mass or trauma. The follow-up period ranged from 3 to 31 months. MAIN OUTCOME MEASURE: Lid position. RESULTS: All eyelids included in this study were corrected to 1 mm of the desired result. There were no incidents of peaking or recurrence on long-term follow-up. Complications included one case of hematoma and a case of slight tenting of the eyelid margin. CONCLUSIONS: This procedure combines the physiologic approach of levator aponeurosis surgery with the simplicity and flexibility of a single adjustable "hang-back" type suture. It may readily be combined with other procedures such as blepharoplasty. It is also useful when the "ideal" lid level may not be determined until the postoperative period, such as eyes subject to ptosis by Hering's law, levator dehiscence, or those at increased potential risk for corneal exposure.     

Advancement of Whitnall's ligament via the conjunctival approach for correction of congenital ptosis

PURPOSE To conduct a preliminary study on ptotic eyelids with unilateral, congenital, simple partial ptosis, operated by advancement of Whitnall's ligament via the conjunctival route. METHOD A prospective, interventional, clinical study. RESULTS A total of 10 patients were recruited. The ptosis was 4 mm or less (range 2-4 mm; mean 2.7) and LPS action was greater than 5 mm (range 6-14 mm; mean 9.7). The ptosis was corrected by advancement of Whitnall's ligament by plication of the levator aponeurosis via the conjunctival route. Postoperatively, correction within 1 mm of the normal lid height was taken as good correction. All patients were assessed for a minimum of one year with regard to the amount of correction, residual ptosis, lid lag and lagophthalmos. In our study, good correction, i.e. within 1 mm of the normal fellow eye in primary gaze, was obtained in 80% of patients. Patients with more than or equal to 8 mm levator function gave better results. Undercorrection occurred in two patients. Lid lag and lagophthalmos occurred in all patients but was within acceptable limits. CONCLUSION Advancement of Whitnall's ligament by plication of the levator aponeurosis via the conjunctival route is a viable procedure, which has all the advantages of performing the same technique via the cutaneous approach, i.e. shorter surgical time, minimal dissection of tissue planes and reversibility. The conjunctival approach has the added advantage of being cosmetically more acceptable as there is no visible scar on the lid. The technique also offers satisfactory functional results with few (correctable) complications.     

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.     

同期手术矫正上睑内翻倒睫合并老年性上睑下垂

目的：评价同期手术治疗上睑内翻合并老年性上睑下垂的手术效果。
　　方法：将2010-06/2013-06明确诊断为上睑内翻合并腱膜性上睑下垂的患者30例60眼同期行上睑内翻倒睫矫正合并提上睑肌缩短合并前徙术,观察手术后效果。
　　结果：术中全部矫正良好,分别于1 wk;1,6 mo对参选患者内翻及倒睫矫正情况及上睑遮盖上方角膜缘程度进行观察。上睑内翻倒睫得到完全矫正。上睑遮盖上方角膜缘垂直距离术后1wk 为1.68±0.71mm,1mo 为1.71±0.69mm,6mo为1.70±0.65mm,均较术前相比差异有统计学意义(P<0.05)。术后无暴露性角膜炎,无过矫发生。
　　结论：多数患有上睑内翻倒睫的老年人同时合并有老年性上睑下垂,眼科医生应该重视上述两种病变的合并存在,并同时矫正。同期行上睑内翻矫正合并提上睑肌缩短的方法治疗上睑内翻倒睫合并老年性上睑下垂,可取得满意疗效。     

A quantitative approach to shortening the levator palpebrae superioris to correct congenital ptosis in children

AIM: To develop a feasible method to correct congenital ptosis in children. METHODS: Sixty-four patients (102 eyelids) were divided into three groups based on the degree of ptosis: mild (<2 mm); moderate (3-4 mm); and severe (>4 mm). All patients underwent the same levator resection surgery in which the suspensory system of the LPS is retained. After capturing a standard photograph of primary position, the height of the superior palpebral margin was measured preoperatively by using Image J software to calculate its ideal height required during surgery. Postoperative outcome measures included upper eyelid margin height, degree of scleral exposure and exposure keratitis. The patients were followed-up at 1wk, 1mo and 6mo postoperatively. RESULTS: In the early postoperative period, except two cases with overcorrection, the positions of the eyelid upper margins were normal in all cases in the mild and moderate groups. Six months postoperatively, the eye with overcorrection in the moderate group showed improvement, while the eye in the mild group did not. Seven eyes in the severe group exhibited residual ptosis to varying degrees. The eyelids exhibited appropriate closing functionality; exposure keratitis was absent. CONCLUSION: Using this preoperative quantification technique to guide surgery not only provide a gauge for LPS shortening under general anesthesia, but also increase the success rate of surgery.     

Isolated Muller's muscle resection for the correction of blepharoptosis

PURPOSE: To assess the outcome of isolated Muller's muscle resection with preservation of conjunctiva in patients with blepharoptosis and good to moderate levator function. METHODS: This study was designed as a prospective, nonrandomised case series. Thirty-four eyes of 27 blepharoptosis patients were operated on, who were phenylephrine test-negative as well as positive. Open-sky Muller's muscle resection was performed with preservation of the conjunctiva. Main outcome measures were increase in margin reflex distance (MRD1), eyelid contour, and symptoms and signs of dry eye. RESULTS: The mean increase in MRD1 was 2.75 mm. All but one patient (96%) had upper lid margins resting at or up to 1 mm below the limbus and obtained symmetry to within 0.5 mm of the fellow eye. No patients had symptoms or signs of dry eye. CONCLUSION: Isolated Muller's muscle resection is effective for the correction of ptosis in patients with moderate to good levator function. This is irrespective of the lid's response to phenylephrine. Preservation of conjunctival tissue eliminates concerns about dry eye, and also preserves the full height of the fornix.     

全身麻醉下行儿童先天性上睑下垂提上睑肌缩短术的量化研究

目的：探寻一种全身麻醉下行提上睑肌缩短术时术前量化的方法。

方法：收集64例102眼儿童上睑下垂患者, 根据上睑下垂的程度将其分为三组：轻度(<2 mm),中度(3～4 mm)及重度(>4 mm)。所有病例均采用提上睑肌缩短术,术前采集标准照片, 并通过Image J软件测量患眼上睑缘至角膜下缘的高度,利用公式计算出术中上睑缘需达到的高度,并根据计算结果实施手术。术后评价标准包括上睑缘高度,巩膜暴露度以及暴露性角膜炎的发生情况。所有患者均于术后1wk,1mo、6mo时进行随访。

结果：在术后早期阶段,轻、中度组各1眼出现过矫情况,轻度组和中度组所有患者的上睑缘位置均位于正常高度。术后6mo时,中度组的过矫眼有所提高,轻度组的过矫眼仍处于过矫状态,重度组中有7例出现了不同程度的欠矫。术后眼睑闭合良好,未出现暴露性角膜炎。

结论：这种术前通过公式计算全身麻醉下上睑下垂患者术中需要达到的上睑缘高度的方法,不仅为全身麻醉下行提上睑肌缩短术提供更为准确的依据,同时也提高了全身麻醉下行提上睑肌缩短术的成功率。     

Maximal levator resection in the treatment of unilateral congenital ptosis with poor levator function

From 1994 to 1999, 1121 operations for blepharoptosis were performed in our department on 987 patients. In 44 cases we found a moderate to severe congenital ptosis with a levator function of less than 2 mm. Until today, in such cases, it is recommended to use a frontalis suspension in order to elevate the upper eyelid. Unsatisfactory cosmetic results in facial expression and lack of skin-fold are only a few of the disadvantages of this technique. In 1994, therefore, we decided to perform a maximal levator resection in the treatment of unilateral congenital ptosis with poor levator function. All children included in our study were younger than six years of age. The ptosis was moderate (2-4 mm) in 36/44 and severe (>4 mm) in 8/44 cases. The levator function was less than 2 mm. Complete transsection of the medial and lateral horn of the levator aponeurosis under preservation of the Whitnall ligament is the most important surgical step in mobilizing the levator muscle. A satisfactory eyelid elevation (generally considered to be a difference of less than 1 mm between both eyelid fissures) was achieved in 36/44 cases. Our results indicate that, in contrast to established practice, maximal levator resection is the treatment of choice for congenital ptosis with poor levator function.