改良双切口额肌瓣吻合术治疗重度上睑下垂

目的 探讨改良额肌瓣吻合术治疗重度上睑下垂手术的效果.方法 采用改良的双切口额肌瓣吻合术治疗重度上睑下垂18例(20眼).其中先天性重度上睑下垂16例(18眼),外伤性重度上睑下垂2例(2眼).结果 术后上睑缘位于角膜上缘之上2 mm,术后1周时,上睑缘下降至角膜上缘之下1～2 mm.重睑和睑缘弧度自然美观,无畸形.先天性重度上睑下垂矫正术后睑裂闭合不全于3～6个月恢复.结论 该手术效果良好.适合于治疗重度上睑下垂.     

经典提上睑肌缩短术治疗重度先天性上睑下垂

目的评估经典提上睑肌缩短术治疗重度先天性上睑下垂及手术治疗效果。方法重度先天性上睑下垂20眼行经典提上睑肌缩短术结果本文16例20眼,平均随访6个月。术后睑裂高度7～9mm者18眼,6mm者2眼,双眼睑裂对称,重睑弧度自然,部分病例有轻度睑裂闭合不全,4眼一过性轻度结膜脱垂。结论该术式矫正重度先天性上睑下垂效果良好。     

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。     

提上睑肌缩短术治疗儿童重度上睑下垂

目的:观察提上睑肌缩短术治疗肌力<4mm的重度先天性上睑下垂的效果。方法:对肌力在4mm以下的重度先天性上睑下垂58例84眼行提上睑肌缩短术,观察并分析术后上睑的高度,睑裂宽度,上睑的弧度及重睑形态。结果:本组病例中,正矫64眼(76.2%);轻度欠矫(上睑缘位于上方瞳孔缘或上方瞳孔缘下1mm)18眼(21.4%),复发(上睑缘高度较术前无提高)2眼(2.4%)。欠矫的病例中有6例伴外侧1/3重睑沟变浅。无过矫病例,无暴露性角膜炎病例。结论:提上睑肌缩短术治疗肌力<4mm的重度先天性上睑下垂可取得满意效果。但在手术的最低年龄及探求少部分失败病例的原因等方面还有待进一步研究。     

硬脑膜额肌悬吊治疗儿童重度先天性上睑下垂

目的 探讨利用异体硬脑膜作为悬吊材料治疗儿童重度先天性上睑下垂的手术效果。方法对27例43眼重度先天性卜睑下垂的儿童行异体硬脑膜额肌悬吊术。结果 术后随访3～32个月，所有患儿外观改善，睑缘弧度美观，符合生理状态。结论 异体硬脑膜额肌悬吊治疗儿童重度先天性上睑下垂，手术方法简单可靠，术后效果良好，值得临床推广。     

先天性上睑下垂的手术矫正

目的报告先天性上睑下垂手术矫正的效果,并对其疗效进行评价。方法对234例(308眼)先天性上睑下垂病人,均采用前路提上睑肌缩短术,重度上睑下垂采用提上睑肌超常量缩短术。结果术后平视睑裂高度6～9mm者280眼(90.9%),上睑缘弧度及双重睑形成良好,双侧眼窝深度对称。197眼重度上睑下垂行提上睑肌超常量缩短术后均有不同程度的睑裂闭合不全,术后1～3月恢复眼睑闭合功能,10眼结膜脱垂。结论该术式是治疗先天性上睑下垂比较理想且符合解剖生理的可行术式。目的报告先天性上睑下垂手术矫正的效果,并对其疗效进行评价。方法对234例(308眼)先天性上睑下垂病人,均采用前路提上睑肌缩短术,重度上睑下垂采用提上睑肌超常量缩短术。结果术后平视睑裂高度6～9mm者280眼(90.9%),上睑缘弧度及双重睑形成良好,双侧眼窝深度对称。197眼重度上睑下垂行提上睑肌超常量缩短术后均有不同程度的睑裂闭合不全,术后1～3月恢复眼睑闭合功能,10眼结膜脱垂。结论该术式是治疗先天性上睑下垂比较理想且符合解剖生理的可行术式。     

提上睑肌折叠联合额肌吻合术29例的临床疗效

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，采用提上睑肌折叠联合额肌吻合术。结果 30眼上睑下垂术后早期平视时上睑缘遮盖上方角膜1-2mm25眼，睑裂为6-9mm为32眼（91.8%)，术后平均随访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。     

提上睑肌缩短术治疗重度先天性上睑下垂

目的:探讨采用提上睑肌缩短术治疗重度先天性上睑下垂的效果及可行性。方法:对30例(34眼)患重度先天性上睑下垂患者,分别在局麻下行经皮肤面的提上睑肌缩短术,术前均进行详细的检查以除外垂直肌麻痹,jew-wink现象,重症肌无力等,bell( )现象,上睑下垂程度用berke法:均>4mm以上,提上睑肌功能均<4mm以下,缩短量为18～24mm。结果:30例(34眼)重度先天性上睑下垂患者经用提上睑肌缩短术治疗均获满意效果,上睑缘位于角膜缘下1～3mm,双侧睑裂大小,重睑高度基本一致,睑缘弧度自然流畅,睑闭合无角膜暴露,皱额耸眉姿态消失,随诊0.5～3a,效果满意。结论:经皮肤面的提上睑肌缩短术术野暴露好,可最大限度的充分游离提上睑肌,且年龄小,肌肉弹性好,矫正度数大,可以矫正重度先天性上睑下垂,且效果确实,可行。     

异体硬脑膜额肌悬吊术治疗上睑下垂远期效果

目的观察异体硬脑膜额肌悬吊术治疗重度先天性上睑下垂的远期疗效。方法对28例（49眼）术后患者随访3～5年观察。结果上睑下垂完全矫正或基本矫正，睑缘弧度美观，符合生理，睑裂闭合良好。结论异体硬脑膜额肌悬吊术治疗重度先天性上睑下垂，术后效果良好、且较稳定。     

改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂

目的:探讨改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂的有效性。方法:20例(25眼)学龄前儿童先天性重度上睑下垂,采用改良式额肌瓣悬吊术,利用额肌力量提起上睑。结果:术后1～4a上睑缘位于角膜上缘下1mm20眼,2mm5眼,无复发。结论:改良式额肌瓣悬吊术治疗学龄前儿童先天性重度上睑下垂效果肯定。     

全身麻醉下额肌瓣悬吊治疗小儿单眼重度先天性上睑下垂

目的:观察全身麻醉下额肌瓣悬吊术治疗小儿单眼重度先天性上睑下垂的临床效果和特点。方法:对23例小儿单眼重度先天性上睑下垂行全身麻醉下额肌瓣悬吊术,男13例,女10例,2.5～7(平均4.6)岁,患眼提上睑肌力2～4(平均3.1)mm;术前确定健眼平视前方时上睑缘的位置(在上提患眼睑缘至与对侧眼等高时)。术中根据全身麻醉下眼位略上转的状态及术前健眼上睑缘的位置,将患眼睑缘上提至上角巩缘以下1～3mm。结果:随访1wk～1a,20例(87%)双眼睑缘完全或基本等高(双眼上睑缘高度差在1mm内),3例(13%)欠矫,双眼睑缘高相差约2～3mm。所有病例外观术后均较术前有明显改善或改善,均无严重的睑缘畸形、睑外翻和暴露性角膜炎等并发症,但有6例患儿术后外侧睑缘稍低,与对侧眼略不对称。结论:全身麻醉下额肌瓣悬吊术治疗小儿单眼重度先天性上睑下垂关键在于术前确定健眼上睑缘的位置,并根据术中实际眼位的变化确定上睑缘上提的量。     

良提上睑肌缩短术治疗成年人重度先天性上睑下垂

目的 探讨改良提上睑肌缩短术治疗成年人重度先天性上睑下垂的可行性及疗效。设计  回顾性病例系列。研究对象 2013年1月-2014年12月治疗的单眼或双眼发病的成年人重度先天性上睑下垂患者27例（36眼）。患者年龄18~45岁。方法 对上述患者行术前常规检查，排除眼肌疾患，均采用提上睑肌缩短联合腱膜深面固定手术，术中单纯分离提上睑肌腱膜，保留Müller肌与睑板和结膜的关系。术后随访1年，观察临床疗效。以平视时上睑缘位置作为评价标准：位于角膜上缘下1~2 mm，睑缘弧度自然，无并发症者为满意，位于角膜缘以上者为过矫，低至瞳孔上1/3者为欠矫，遮挡瞳孔大于1/3者为复发。主要指标 上睑缘位置、眼睑弧度及有无并发症（睑内翻、结膜脱垂、暴露性角膜炎）。结果 27例患者术后1年，矫正满意者22例（31眼），眼睑高度基本正常，弧度自然。1眼上睑内翻、2眼结膜脱垂、2眼欠矫。结论 重度先天性上睑下垂成人患者采用改良的提上睑肌缩短术疗效确定，1年内在矫正眼睑生理功能和改善外观上达到满意效果。（眼科，2018, 27： 362-365）     

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.     

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。     

Early Frontalis Flap Surgery as First Option to Correct Congenital Ptosis with Poor Levator Function

Abstract

In congenital blepharoptosis the upper eyelid cannot be lifted normally because of congenital impairment in the levator function. The descended eyelid margin partially or completely obstructs of the visual axis with the consequent risk of amblyopia. Frontalis suspension is the surgery of choice for ptosis with poor levator function creating a linkage between the frontalis muscle and the tarsus; the frontalis muscle is used to elevate the eyelid. Direct transplantation of frontalis muscle to the upper eyelid has been widely described. We report our experience using frontalis flap in congenital ptosis with poor levator function in children.

Methods: Retrospective study of 30 eyes with severe congenital ptosis and poor levator function treated by means of direct frontalis flap. Mean age 2 years. Eyelid measurements were taken at baseline, 1, 3, 12 months postoperatively and last visit. Mean ptosis degree was 5?mm (3--8?mm) and levator function 2?mm (1--5?mm). The presence of complications, flap function and palpebral contour were evaluated. Mean follow up time was 27 months. At last visit, ptosis degree ranged from 0 to 3?mm.

Discussion: Direct advancement of the frontalis muscle to treat severe eyelid ptosis is effective and stable in the long term avoiding the use of a linking structure, therefore the risk of foreign-body reaction, absorption, granuloma and late exposure, as well as the need for a second visible incision in the forehead. Patients learn how to control the lid height by means of the frontalis muscle achieving more symmetry.     

改良额肌瓣悬吊术治疗先天性上睑下垂

目的提高儿童中重度先天性上睑下垂的治疗效果。方法对42例（53眼）中重度先天性上睑下垂的儿童施行改良额肌瓣悬吊术：沿重睑线切开皮肤,剪除部分眼轮匝肌,显露睑板,分别作额肌与皮下、额肌与骨膜间的分离,于眉下提起并横形切断额肌,于其内侧向上切开肌瓣达眉上1-1.5cm,外侧向上剪开0.5cm,形成不等边的额肌瓣,三针褥式缝线固定于睑板上缘。结果42例53眼,切口均一期愈合,随访6月～5年,上睑下垂矫正满意,睑缘外形匀称,上睑闭合良好,无复发和并发症。结论改良式额肌瓣悬吊术治疗儿童先天性中重度上睑下垂疗效确切,远期效果较好。     

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。     

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。     

External levator advancement vs Müller's muscle-conjunctival resection for correction of upper eyelid involutional ptosis

PURPOSE: To compare external levator advancement and Müller's muscle-conjunctival resection (conjunctivomullerectomy, or CJM) for correction of upper eyelid involutional ptosis. DESIGN: Retrospective, nonrandomized, comparative interventional case series. METHODS: Review of medical records of 159 patients (272 surgical procedures) who underwent external levator advancement or CJM was performed. MAIN OUTCOME MEASURES: Functional and cosmetic outcome, marginal reflex distance one (MRD1), and surgical complications. RESULTS: A total of 159 patients (51 men, 108 women, mean age 70 years) underwent 272 surgical procedures for upper eyelid ptosis; concurrent blepharoplasty was performed in 141 cases. MRD1 increased an average of 1.6 (+/-1.5) mm, from 0.8 mm (+/-1.2) preoperatively to 2.3 mm (+/-1.2) postoperatively (P < .001). Fifteen patients (5.5%) underwent reoperation for residual ptosis, nine (18%) in the external levator advancement group, two (3%) in the CJM group, three (8%) in the external plus blepharoplasty group, and one (1%) in the CJM plus blepharoplasty group (P < .001). Patients who underwent external levator advancement had significantly more severe ptosis preoperatively but attained similar eyelid position postoperatively as compared with CJM patients. Complications included overcorrection in four cases (1.4%), lagophthalmos of 1 mm in 10 (3.6%), and pyogenic granuloma in two (<1%). CONCLUSIONS: External levator advancement and CJM performed alone or with concurrent blepharoplasty are effective treatments for upper eyelid ptosis. Residual ptosis or postoperative eyelid retraction occurs in up to 20% of cases and can be addressed successfully with a second operation.