离断眶隔脂肪与上睑提肌腱膜之间的纤维条索治疗轻度上睑下垂

目的探讨治疗轻度上睑下垂的简便方法。方法 2011年以来,对12例轻度上睑下垂患者行上睑下垂矫正术,手术松解离断眶隔脂肪与上睑提肌腱膜之间的纤维条索以矫正上睑下垂。结果本组12例患者,9例患者上睑下垂得到矫正,3例有所改善。术后随访1年,均未见复发,效果满意。结论离断眶隔脂肪与上睑提肌腱膜之间的纤维条索,可矫正轻度上睑下垂,方法简单,效果可靠。     

额肌瓣悬吊术中额肌瓣成形的改进

额肌瓣悬吊术治疗上睑下垂已在临床应用多年。作者于１９９５年，在原基础上进行了改进。方法：切开皮肤、皮下及眼轮匝肌，向上直接分离额肌瓣深层，然后再于眉下进入浅层分离。本法可以减少切口上缘至眉下的浅层分离，组织损伤小，出血少，减轻术后并发兔眼的程度，缩短了手术操作时间。用该法治疗的２６例中、重度上睑下垂患者，疗效良好。     

改良额肌瓣悬吊术矫治儿童先天性上睑下垂的护理

目的探讨改良额肌瓣悬吊术矫治儿童先天性上睑下垂术后采取有效护理措施,促进睑裂恢复正常,扩大视野,改善容貌。方法重点对患儿进行有针对性的心理护理,做好术前准备,术后作好伤口护理、上睑功能锻炼及预防各种并发症等护理。结果16例患儿术后随访3个月-1年,睑裂恢复正常,无视觉致残及护理并发症发生,手术效果满意。结论儿童先天性上睑下垂早期手术尤为重要,加强患儿术前术后心理护理,术后密切观察病情,及时采取相应的护理措施,在很大程度上提高了手术治疗效果。     

额肌筋膜瓣矫正上睑下垂并发症的统计

目的探讨额肌筋膜瓣悬吊术在矫正上睑下垂术后并发症发生的原因及防治措施,提高手术效果。方法对５１３例在住院期间及门诊复查中发现的术后并发症进行病因和防治研究。结果发现术后并发症共１４种并以相应措施防治。结论绝大部分并发症可以防治,额肌筋膜瓣悬吊术矫治完全性上睑下垂的效果可靠。     

Assessing the corneal sub-basal nerve plexus by in vivo confocal microscopy in patients with blepharoptosis

BackgroundTo assess in vivo confocal microscopy features of corneal sub-basal nerve plexus in patients with congenital or aponeurogenic blepharoptosis using a fully automated software (ACCMetrics).Patients and methodsThis prospective study included 33 patients with blepharoptosis and 17 normal controls. The corneal sub-basal nerve plexus was assessed using in vivo confocal microscopy, and the ocular surface status was evaluated by tear break-up times.ResultsThe mean age of 33 patients with blepharoptosis and 17 normal controls were 38.77 ± 22.81 years and 48.35 ± 17.15 years, respectively. The mean duration of blepharoptosis was 16.42 ± 15.60 years. In 13 patients with unilateral blepharoptosis, there was no significant difference between affected eyes and contralateral eyes (all ps > .05), except for wider corneal nerve fibre width (CNFW) in affected eyes (0.024 ± 0.001 versus 0.023 ± 0.001 mm/mm², p = .021). In 20 patients with bilateral blepharoptosis, there was no significant difference between the eyes. No significant difference was detected between 19 cases with congenital blepharoptosis and 14 cases with aponeurogenic blepharoptosis. When compared with normal controls, eyes with both unilateral and bilateral blepharoptosis had significantly wider CNFW. But from the point of aetiology, only eyes with congenital blepharoptosis presented with wider CNFW (p = .001), rather than the eyes with aponeurogenic blepharoptosis (p = .093). Besides, four young patients with congenital blepharoptosis revealed very sparse sub-basal nerve plexus.ConclusionsThese data suggested that corneal confocal microscopy demonstrated no significant changes in patients with blepharoptosis as compared with normal controls, except for relatively wider CNFW in congenital affected eyes. However, in some children and young adults with congenital blepharoptosis, the density of corneal sub-basal nerve plexus was evidently decreased, which needs to be cautioned when ones with congenital blepharoptosis want to take corneal surgeries or wear contact lens.

Key messages

• When compared with normal controls, no significant effect was found in the influence of blepharoptosis on the most of corneal nerve parameters, except for corneal nerve fibre width (CNFW) in the group of congenital blepharoptosis.
• The age of onset of blepharoptosis may influence corneal nerve fibres, so timely surgical treatment of congenital blepharoptosis is not only conducive to the development of normal vision, but also beneficial to the reduction of corneal nerve lesions to some extent.
• We noted that some young blepharoptosis patients revealed sparse corneal nerve, which should be taken precaution when ones with congenital blepharoptosis who want to take corneal surgeries or wear contact lens.

     

额肌筋膜瓣悬吊术矫正重度上睑下垂的临床观察

目的 探讨额肌筋膜瓣悬吊术矫正重度上睑下垂的临床疗效.方法 采用额肌筋膜瓣悬吊术矫治重度上睑下垂45例（60只眼）.结果 矫正良好者39例（占86.67%）,基本矫正者6例（占13.33%）,无矫正不足患者.术后早期眼睑闭合不全现象1个月后逐渐消失.随访3个月～2年,效果稳定.无明显并发症发生.结论 额肌筋膜瓣悬吊术矫正上睑下垂睑缘弧度美观、自然,效果持久、稳定,且取材方便、无额外切口,是一种矫正重度上睑下垂的理想方法.     

Results of Long-Term Follow-Up Observations of Blepharoptosis Correction Using the Palmaris Longus Tendon

BACKGROUND: The frontalis sling procedure is a useful approach for correcting severe blepharoptosis. However, blepharoptosis often recurs after corrective surgery using the tensor fascia lata. Good results without recurrence after a modified Fox method were obtained using the palmaris longus tendon. This study examined the safety and validity of the surgical method using the palmaris longus tendon through long-term follow-up observations. METHODS: To reduce the rate of recurrence, the highest point on the pentagon of the Fox method was fixed to the frontalis fascia and frontalis muscle. It was fixed once again to the area 1 cm above the highest point. This approach remarkably reduces the incidence of recurrence by fixing the pentagon of the Fox method not only to the palmaris longus tendon but also to the frontalis fascia and again to the frontalis muscle. A modified Fox method using the palmaris longus tendon was used to treat 16 eyelids of 10 patients. A senior surgeon performed the procedure in all cases under local anesthesia. RESULTS: The mean follow-up period was 51 months (range = 18-86 months). There was no case of blepharoptosis recurrence and a good field of view was secured after surgery. Long-term follow-up revealed that the visual field had been well secured with a mean MRD1 of 3.1 mm. The eyelids were well maintained without any postoperative adverse reaction such as exposure keratitis. CONCLUSION: The palmaris longus tendon as useful donor material does not lead to recurrence of blepharoptosis, which is often encountered when the tensor fascia lata is used. The modified Fox method using the palmaris longus tendon can be an effective and valid surgical approach that produces both immediate and long-term results.     

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.     

以额肌为动力治疗上睑下垂方法的改进

目的 探索一种简便、实用的以额肌为动力治疗上睑下垂的方法的改进。方法 对22例不同程度的上睑下垂患者仍利用额肌作为动力,将分离的额肌筋膜直接固定于睑板上缘进行治疗。术中经重睑成形术切口将额肌筋膜与皮下组织充分游离,在眶上缘下横行切开额肌筋膜长约1．5cm,在骨膜表面向上分离额肌筋膜,至眶上1．5cm左右,不制作额肌筋膜瓣,然后将分离的额肌筋膜直接向下牵拉与睑板上缘睑上提肌腱膜缝合固定3～4针,并调整固定至张力适度为止,术中无需分离眼轮匝肌后隧道。结果 22例伤口均I期愈合,睁眼时无抬眉、皱额表现,重睑外形佳,双眼对称,手术效果良好,患者满意。经3～6个月随访,无1例复发。结论 借用额肌作为动力,将额肌筋膜直接与睑板上缘缝合悬吊治疗上睑下垂,方法简便,疗效稳定,损伤小,并发症少。此方法可应用于额肌功能正常的各型上睑下垂患者。