老年性上睑皮肤松垂及睑内翻矫正术

0引言随着年龄的增长,上睑皮肤逐渐老化,表现为不同程度的松弛下垂,尤以上睑外侧为著。典型者呈“三角眼”畸形,重者遮盖视野,影响视力,部分沙眼结膜炎较重的患者还伴有睑内翻倒睫,“镰刀形”切除上眼睑皮肤及部分眼轮匝肌,外睑部部分眶膈脂肪球,对部分倒睫患者切削增厚睑板,取得了良好的临床效果。1临床资料我院2004-01/2010-01共治疗上睑皮肤松垂186例,其中睑内翻倒睫15例,年龄40~70岁,其中1例外睑矫正不足,4a后再次手术矫正。手术方法:术前划线,确定上睑皮肤的切除量,重睑线划在距上眼缘4~5mm处,由内眦至外眦划线到外眦角外3~5mm处,然后用镊子自重睑线向上夹持上眼皮肤确定切除皮肤     

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。     

眼轮匝肌束悬吊木矫治上脸下垂(摘要)

1979年以来我院选用眼轮匝肌束悬吊术治疗上睑下垂,效果较其他手术方式更为满意。本组30例(34眼)中男15眼,女19眼;单眼26例,双眼4例。采用拇指对患者眉弓部重压法检测提上睑肌功能,完全性上睑下垂8眼(上睑有1～2mm提移范围);轻度上睑下垂4眼(上睑缘遮盖瞳上缘,中度上睑下垂18眼(上睑缘遮盖瞳孔一半)。重度上睑下垂4眼(上睑缘遮盖瞳孔一半以上)。手术方法:局麻,结膜囊置一角板,距睑缘4～5mm平行睑缘切开皮肤深达眼轮匝肌前。分离皮下组织暴露眼轮匝肌,在内、外背部切断眼轮匝肌的肌束(根据需要取其长度     

中国汉族下睑赘皮性倒睫儿童睑缘宽度的人体学测量

目的 使用眼科规尺测量中国汉族下睑赘皮性倒睫儿童的睑缘宽度。方法 前瞻性单中心观察性研究。使用眼科规尺通过手术显微镜,在全麻状态下对194例下睑赘皮性倒睫儿童进行睑缘宽度的测量。结果194例下睑赘皮性倒睫儿童中男性97例,女性97例,平均年龄6.30±2.94岁(2～14岁),均为汉族。下睑赘皮性倒睫儿童的睑缘宽度:上眼睑内侧、中央、外侧的睑缘宽度分别为1.35±0.29mm,1.61±0.29mm,1.71±0.26mm,上睑睑缘平均宽度为1.56±0.32mm。下眼睑内侧、中央、外侧的睑缘宽度分别为0.94±0.22mm,0.97±0.20mm,1.18±0.25mm,下睑睑缘平均宽度为1.03±0.25mm。不同性别比较,睑缘宽度无显著性差异;不同年龄分组比较,≥8岁儿童的上睑缘宽度明显大于8岁以下的儿童,而下睑无显著性差异。结论 下睑赘皮性倒睫儿童的上睑睑缘宽度明显大于下睑睑缘宽度,上睑外侧睑缘最宽,下睑内侧睑缘最窄。睑缘宽度与性别无关,与年龄有关。本研究为儿童人体学测量提供数据。     

上睑皮肤松弛症的治疗

随着我国人口的老龄化发展,人们生活水平质量的提高,眼睑松弛症的患者逐年增多,而35岁以上女性均会出现不同程度的上睑皮肤松弛,其发生率约在85％左右[1],因其严重影响人们的生活和美观,要求治疗眼睑松弛症的患者也逐年增多.上眼睑成形术几乎占中老年患者眼部美容手术之首位[2].眼睑松弛症的发生与年龄、遗传,生活习惯等因素有关.以往的治疗方法是在重睑线切开皮肤去皮,术后形成的重睑形态臃肿不自然,改善面部形态效果较差.本组65例(102眼)上睑皮肤松弛,采取眉缘下切口,根据上睑松弛程度,上睑是否有眶脂肪脱出,是否伴有筋膜性上睑下垂,分别行单纯松弛皮肤切除术、取皮+眶脂肪切除+眶隔加固术、取皮+提上睑肌筋膜折叠加强术,观察治疗效果.     

重度先天性上睑下垂的早期手术治疗

目的探讨儿童重度先天性上睑下垂早期手术治疗方法。方法采用改良的双切口提上睑肌腱膜瓣-额肌吻合术治疗15例(22眼)重度先天性上睑下垂合并遮蔽性弱视的患儿，年龄4～12岁(平均6．5岁)。结果术后上睑缘高度变化具有明显规律性，术后早期上睑缘回落较快，幅度较大，一般在术后1周时，平均下降2．5mm；术后1个月时上睑缘高度又有所回升，平均1mm；术后3个月上睑缘高度再次缓慢下降，直至术后半年时稳定。随访1年，18眼上睑缘位于角膜缘下1～2mm。重睑和睑缘弧度自然美观；4眼上睑缘位于瞳孔上缘，重睑和睑缘弧度自然美观。术后睑裂闭合不全，一般在术后3个月至半年时消失。本组病例均未发生其它术后并发症。结论该手术方法适用于早期治疗儿童重度先天性上睑下垂。     

中老年人上睑皮肤松弛的矫治

自1997年以来,对上睑松弛、眉下垂手术通过探索、改进、实践,制定相应的立体设计方案,临床治疗效果良好,现报告如下. 1 资料与方法 1.1 一般情况受术者138例276只眼,女112例,男26例.年龄32～56岁.单纯性上睑皮肤松垂者118例,伴眉下垂者20例.1.2 手术方法受术者采取端坐位,双眼自然平视,对上睑皮肤轻度松弛者,用美蓝在下垂的上睑皮肤最下缘转折处上方1mm位置标出数点,连点成弧线.对上睑皮肤明显松弛者,用美蓝在下垂皮肤与其睑缘上方2 mm的位置标出数点连成弧线即是皮肤切除量第二标志线(即切口下线).     

提上睑肌缩短术治疗儿童先天性上睑下垂疗效分析

目的探索不同程度儿童先天性上睑下垂提上睑肌缩短术的疗效及手术时机对疗效的影响。方法对22例(26只眼)儿童先天性上睑下垂病例均采用经皮入路提上睑肌缩短术,手术年龄3~16岁,其中19例(20只眼)为3~6岁,重症病例9例,轻中症13例。结果本组22例术后矫正满意20例(23只眼)、过矫1例、欠矫2例,随访3个月~3年,1例过矫患者术后1周上睑缘轻度回缩,余无明显上睑缘回缩,无暴露性角膜炎、倒睫及结膜脱垂。结论经皮入路提上睑肌缩短术对于不同程度上睑下垂,手术均能达到满意效果,手术并发症发生率低,对幼儿疗效确切,手术符合生理。     

硅胶带悬吊术治疗上睑下垂的改进

临床上矫正上睑下垂的手术方法很多,而且手术的方法在不断的改进和创新。1994年3月至1997年9月,我们用改进的方法,将硅胶带∩型置入额肌上睑间,作悬吊术治疗上睑下垂,取得良好的效果,现总结报告如下。一般资料:本组25例32眼,其中男14例18眼,女11例14眼,年龄最大32岁,最小7岁,先天性上睑下垂22例;外伤性上睑下垂2例;复发性上睑下垂1例;睑裂小于3～4ｍｍ20例26眼,小于5ｍｍ5例6眼。上睑提肌肌力0～1ｍｍ27眼,2ｍｍ5眼。手术方法:(1)标记距上睑缘4～5ｍｍ,眉弓上3ｍｍ位于两侧各长5ｍｍ长的皮肤切口画线。(2)眼睑皮下、眉弓上部和眉睑间浸润麻…     

上睑皮肤松垂切口设计的改进

中老年人上睑组织常有不同程度松垂 ,轻者可见上睑皮肤向下悬垂 ,重者遮挡视线 ,影响患者功能和容貌。随着社会经济的发展 ,人民生活水平的不断提高 ,要求做睑成形手术的人越来越多。上睑成形术中组织切除量的多少对手术效果至关重要 ,也最难掌握 ,在大量实践的基础上 ,我们对以往应用的手术切口设计方法进行了改进 ,采用术前设计、术中校正 ,外眦上方二次切除的方法 ,取得满意效果 ,介绍如下。1　临床资料本组病例 2 989,均为女性 ,年龄最小 2 5岁 ,最大72岁 ,平均 4 6岁。上睑皮肤松垂超过睑缘者 1 685例 ,其中接近或遮盖部分瞳孔 ,影响视…     

Quantitative Comparison of the Effect of 10% Phenylephrine Instillation and Manual Elevation in Patients with Involutional Blepharoptosis

Objective: To compare the effect of 10% phenylephrine (PE) instillation and manual elevation (ME) on the upper eyelid position of the tested eye and the contralateral eye in patients with involutional blepharoptosis (IB). Methods: IB patients were submitted to two tests followed by observation of the effect on the contralateral eyelid: (1) ME of the more ptotic eyelid; and (2) instillation of two drops of 10% PE (phenylephrine test) in the more ptotic eye. The patients were filmed before and 5, 10, and 15 minutes after instillation. The upper eyelid margin reflex distance (MRD1) was measured using the software Image J, and the results were analyzed with the linear mixed-effects model. Results: The study included 70 patients aged 44–86 years, 64 of whom were female (91.43%), divided into three groups: subjects with unilateral IB, subjects with bilateral IB, and controls. The eye submitted to instillation with 10% PE displayed significant elevation during the first 10?min: from 1.33?±?0.66?mm to 2.06?±?0.89?mm (unilateral group), from 1.26?±?0.63?mm to 2.29?±?0.86?mm (bilateral group), and from 3.12?±?0.68?mm to 4.06?±?0.92?mm (control group). MRD1 decreased in the contralateral eye in IB patients, significantly more so after the phenylephrine test: PE vs. ME?=?18.9% versus 17.2% reduction in the unilateral group, and 13.6% versus 10.7% reduction in the bilateral group. The outcome was not influenced by IB severity and the concurrence of IB and eye dominance. Conclusion: Both ME and 10% PE affected the contralateral upper eyelid, but the response was significantly better with the latter.     

The effect of upper eyelid blepharoplasty on eyelid and brow position

This article evaluates the effect of upper eyelid blepharoplasty on eyelid margin position and brow height. This study is a retrospective analysis of patients who underwent upper eyelid blepharoplasty without concurrent blepharoptosis repair or brow surgery. The medical records of the participants were retrospectively reviewed and an established image analysis software was used to quantify the upper margin reflex distance (MRD1) as well as brow height using high quality standardized clinical photographs. A total of 19 patients (38 eyelids and brows) met the inclusion criteria. The mean preoperative MRD1 was 2.8 mm, and the mean post-operative MRD1 was 3.5 mm, revealing an increase of MRD1 from upper blepharoplasty alone of 0.7 mm (p = 0.0001). The mean preoperative brow position was 17.5 mm above the pupil, and the mean post-operative position was 17.4 mm, for an average change of position of -0.2 mm (p = 0.39) following upper eyelid blepharoplasty. Upper eyelid blepharoplasty without ptosis surgery results in a statistically significant increase in MRD1. Brow position does not demonstrate a statistically significant change in patients who undergo upper eyelid blepharoplasty for simple dermatochalasis.     

Maximal Levator Muscle Resection for Primary Congenital Blepharoptosis with Poor Levator Function

Purpose: To evaluate the clinical outcomes of maximal levator muscle resection surgery in patients with poor levator function. Methods: This prospective study included 29 eyelids of 23 patients who underwent maximal levator resection surgery. Pre- and postoperatively, all patients’ routine ophthalmic examination including evaluation of upper eyelid skin crease positions; levator muscle function (LF), rima palpebrarum (RP), and margin-reflex distance (MRD) measurements were recorded. Outcome was considered successful when the difference between the two upper eyelids was ≤1?mm; if the difference between the two eyelid margins was more than 1?mm and less than 2?mm, it was considered to be satisfactory. More than 2?mm difference was considered to be poor. Results: Mean patient age was 11.3?±?8.6 years (3 months to 24 years). Mean follow-up time was 22.8?±?6.9 months (10 to 36 months). Preoperatively mean RP, MRD, and LF measurements were 5.5?±?1.7?mm, ?0.14?±?1.6?mm, 2.5?±?1.4?mm (0–4?mm), respectively. Preoperatively, eight (27,6%) patients had skin crease. Abnormal head posture was detected in eight (34.8%) of the patients. Postoperatively, RP, MRD, and LF values increased significantly (p?Conclusions: Maximal levator resection may be a good alternative method to frontalis suspension in congenital blepharoptosis patients with poor levator function.     

Simultaneous ipsilateral transconjunctival repair of upper and lower eyelid retraction in thyroid-associated ophthalmopathy

Purpose: To report a simple, highly effective technique of simultaneous transconjunctival repair of upper and lower eyelid retraction in patients with thyroid eye disease (TED).

Methods: A retrospective interventional case review was conducted on 22 eyes of 19 TED patients. The lower eyelid was recessed with placement of a tarsoconjunctival spacer graft harvested from the upper eyelid. The upper eyelid was then recessed through the conjunctival incision used to harvest the tarsal graft. A temporary tarsorrhaphy was placed for 5–7 days. The postoperative outcome was assessed by measuring the margin reflex distance of the upper eyelid (MRD1), inferior scleral show (ISS), and lagophthalmos.

Results: The absolute change in MRD1 ranged from 0 to 5 mm with an average of 1.86 ± 1.34 mm. The absolute change in ISS ranged from 0 to 2 mm with an average of 1.3 ± 0.49 mm. One patient had postoperative lagophthalmos and 17 of 19 had improvement in their ocular surface exposure symptoms. None of the patients’ grafts were observed to undergo absorption during the postoperative course.

Conclusions: This technique of harvesting a free tarsoconjunctival graft from the upper eyelid as a posterior spacer for the lower while simultaneously recessing the upper eyelid through the same incision is an effective and durable method of correcting eyelid retraction in TED.     

Reconstructive subperiosteal midface lift: A three nonvisible incision approach

This article describes our surgical technique for subperiosteal midface elevation in patients with paralytic lower eyelid malposition or cicatricial inferior eyelid retraction. Nineteen patients with paralytic lower eyelid malposition and 15 patients with cicatricial inferior eyelid retraction underwent a subperiosteal midface lift (n = 34). The procedure was performed under local anesthesia through three nonvisible incisions. A transconjunctival incision allows preseptal dissection to the orbital rim, followed by a subperiosteal dissection of the midface. An oral incision is useful to achieve complete subperiosteal dissection and to perform the distal periostomy, which allows complete release of the midface soft tissues. A temporal incision provides access to the temporal fascia for fixation of the elevated tissues and gives the surgeon the possibility of removing redundant skin from the scalp instead of the lower eyelid. Additional posterior lamellar grafting was performed in 24 patients. There was a statistically significant reduction in the distance from the pupil centre to the lower eyelid (margin reflex distance, MRD2) 1 month after surgery (preoperative MRD2 9.62 ± 4.52 mm, postoperative MRD2 5.28 ± 2.62 mm). The ectropion and lower eyelid retraction was resolved in all patients, except for one recurrence. Midfacial elevation is a safe and effective surgical technique in the treatment of static lower eyelid malposition after chronic facial nerve palsy or posttraumatic or iatrogenic lower eyelid retraction.     

Blepharoptosis Repair through the Small Orbital Septum Incision and Minimal Dissection Technique in Patients with Coexisting Dermatochalasis

Purpose

To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis.

Methods

A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation.

Results

The pre- and postoperative MRD1 averaged 1.1 ± 0.8 mm and 2.8 ± 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery.

Conclusions

Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis.     

Effect of unilateral blepharoptosis repair on contralateral eyelid position

PURPOSE: This study evaluates the effect of unilateral blepharoptosis repair on contralateral eyelid position and assesses the relation between preoperative eyelid height interdependence, consistent with Hering law, and surgical outcome. METHODS: The medical records of 54 patients (21 men, 33 women; mean age, 65 years) who underwent external levator advancement for unilateral aponeurotic blepharoptosis were reviewed for preoperative and postoperative margin reflex distance (MRD) of the nonoperated eye. To assess the relation between preoperative Hering dependence (mechanical elevation of the ptotic eyelid causing a decrease in contralateral eyelid height) and postoperative eyelid position, the change in MRD of the nonoperated eye was compared between subjects who on preoperative evaluation did (n=18) and did not (n=36) demonstrate eyelid height interdependence, using the 2-sample t test. RESULTS: After unilateral blepharoptosis repair, the mean (+/- SD) change in contralateral MRD was -0.2 +/- 0.8 mm. There was no significant difference in contralateral MRD change in subjects with and without preoperative Hering dependence (-0.3 +/- 0.8 mm versus -0.2 +/- 0.9 mm, respectively, p=0.78). Seventeen percent (9 of 54) of patients had a contralateral MRD decrease of more than 1 mm. Three patients (5.6%) required contralateral blepharoptosis repair within 1 year of initial surgery. CONCLUSIONS: After levator advancement for unilateral blepharoptosis, roughly 17% of patients will have a decrease in contralateral eyelid height of more than 1 mm, with 5% of patients requiring surgical repair during the first postoperative year. The degree of change in contralateral eyelid height cannot be reliably predicted by preoperative assessment of Hering dependence.     

Symmetry of upper eyelid after unilateral blepharoptosis repair with minimally invasive conjoint fascial sheath suspension technique

AIM: To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath (CFS) suspension. METHODS: A retrospective study of patients who underwent unilateral minimally invasive CFS suspension surgery between January 2018 and December 2021. Inclusion criteria included unilateral mild and moderate ptosis, good levator muscle function (>9 mm) and follow-up of at least 6mo. Pre- and post-operative symmetry was graded subjectively for marginal reflex distance 1 (MRD1), tarsal platform show (TPS) and eyebrow fat span (BFS). A t-test was used to evaluate MRD1, TPS and BFS asymmetry by calculating delta values. The Bézier curve tool of the Image J software was used to extract the upper eyelid contours, where the symmetry was measured by the percentage of overlapping curvatures (POC). RESULTS: Totally 105 patients (105 eyelids) were included (mild group, n=84; moderate group, n=21). Postoperatively, all patients increased MRD1 and decreased TPS in the ptotic eye while maintaining unchanged BFS. The asymmetric delta value for MRD1 was measured to be 1.48±0.86 preoperatively, and it decreased to 0.58±0.67 postoperatively in all cases (P=0.0004). In patients with mild ptosis, the asymmetry value of TPS fell significantly from 1.15±0.62 to 0.68±0.38 (P=0.0187). The symmetry of the upper eyelid contour increased in all subgroups of patients, with a POC of 59.39%±13.45% preoperatively and POC of 78.29%±13.80% postoperatively. CONCLUSION: Minimally invasive CFS suspension is proved to be an effective means of improving the symmetry of unilateral ptosis in terms of MRD1 (all subgroups), POC (all subgroups) and TPS (only mild group), whereas BFS is unaffected.     

眉下皮肤切除术矫正中老年上睑松弛的疗效分析

目的：评估眉下皮肤切口矫正中老年女性上睑皮肤松弛的疗效、优缺点及适应征。

方法：收集就诊于山西省眼科医院的30例上睑皮肤松弛患者。所有患者提上睑肌功能正常(均不伴先天性及获得性上睑下垂),手术主要指征为上睑皮肤松弛,尤其外侧松弛明显30例患者均行眉下皮肤切口手术。评估所有患者手术前后的皮肤松弛程度及手术效果,并观察术后并发症。

结果：所有患者均为女性,平均年龄53.20±7.10(40-64)岁,30例患者的上睑皮肤松弛均有效改善。术后1mo,52例效果优,8例效果良。应用客观Strasser系统评价术后1、6mo手术效果,所有患者得分均在0-1分之间,效果优。患者术前不满意的眉毛位置与眉形均有效改善、额纹及鱼尾纹明显减少。所有患者对结果满意。未见伤口裂开、眼睑闭合不全、严重增生性瘢痕等严重并发症发生。

结论：眉下皮肤切除术是一种矫正中老年上睑松弛的有效手段。该手术不仅保留了传统上睑成形术的优点,还可以同时改善眉的位置与形态,并可保留眼睑原有形态,术后皮肤瘢痕小、外观良好,满意度高,并发症少。     

Infrabrow excision to correct upper eyelid dermatochalasis in middle-aged and elderly patients

AIM: To evaluate the effects, advantages, disadvantages, and indications of infrabrow skin excision to correct upper eyelid dermatochalasis in middle-aged and elderly Chinese women. METHODS: Sixty eyelids in 30 patients were subjected to this surgical procedure from January to June 2018. All patients had upper eyelid dermatochalasis, and the functions of their levator palpebrae were all normal. The primary indications of the procedure were upper lid dermatochalasis with lateral hooding. All 30 patients underwent infrabrow skin excision at Shanxi Eye Hospital. The degree of skin relaxation before and after surgery was evaluated in all patients, and surgical outcomes and postoperative complications were also assessed. RESULTS: All patients were female, ranging from 40 to 64 (mean: 53.20±7.10) years old. Skin relaxation of the upper eyelid was improved in all 30 patients. One month after the operation, 52 lids (86.7%) showed good results and 8 lids (13.33%) showed fair results. The objective Strasser system was applied to evaluate surgical results at 1 and 6 months. All patients had scores between 0 and 1 point, indicating good results. Preoperative unsatisfactory position and shape of the eyebrows were improved, and crow''s feet and frontal lines were reduced. All patients were satisfied with the results. No complications related to wound dehiscence, lagophthalmos, or hypertrophic scars were observed. CONCLUSION: Infrabrow skin excision is a simple, useful operation to reconstruct the upper eyelids in selected patients of Chinese ancestry. This procedure not only retains the advantages of classic blepharoplasty, but also alleviates many eyebrow problems at the same time, and maintains the original shape of the eyelid, minimizes scarring, and produces a smoother, more youthful appearance.