上睑提肌缩短术治疗不同年龄不同肌力的重度先天性上睑下垂的疗效观察

目的探讨上睑提肌缩短术对于不同年龄、不同肌力的重症上睑下垂的远期治疗效果。方法观察2008年1月至2009年8月在我院进行治疗的重症上睑下垂32例（40眼）术后1年的效果,所有患者均采用上睑提肌缩短术治疗,手术效果分为良好、尚好、差及过矫4级。所有患者按年龄分为两组（0—5岁组及6—25岁组）,并且按上睑提肌肌力又分为两组（〈2mm,32mm）。结果不同年龄组之间比较：达I级疗效的,两组差异有统计学意义（P〈0．05）;不同肌力组之间进行比较：达I级疗效的,两组差异有统计学意义（P〈0．05）。结论对于重度先天性上睑下垂,只要不影响视功能,可等待至6岁以后采用上睑提肌缩短术治疗,对肌力≥2mm者的疗效优于肌力〈2mm者。上睑提肌缩短术治疗重度先天性上睑下垂。     

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.     

改良的睑板—结膜—Muller氏肌部分切除术矫正上睑下垂

目的：探讨轻度上睑下垂的手术方法及疗效。方法：1991－2000年对15例（18只眼）行改良的睑板－结膜－Muller氏肌部分切除术（Fassnella-Servat operation),术后随访最长9年,最短半年。结果：除1只眼上睑内侧矫正不足外,其余病例均获满意效果。术后有2只眼出现角膜刺激症状,无其它并发症发生。结论：提上睑肌肌力≥10mm、下垂量＜2mm者,用此法疗效良好。     

RESTORATION OF INVOLUNTARY TONIC CONTRACTION OF THE LEVATOR MUSCLE IN PATIENTS WITH APONEUROTIC BLEPHAROPTOSIS OR HORNER SYNDROME BY APONEUROTIC ADVANCEMENT USING THE ORBITAL SEPTUM

Müller's muscle can be thought of as a large serial type of muscle spindle of the levator muscle. Effective stretching of the mechanoreceptor in the proximal part of Müller's muscle by voluntary phasic contraction of the levator muscle for initial opening of the eye induces involuntary tonic contraction of the levator muscle as a stretch reflex via the mesencephalic trigeminal nucleus, to maintain an adequate visual field. After disinsertion of the levator aponeurosis from the tarsus by habitual rubbing, elongation of Müller's muscle secondary to thinning (aponeurotic blepharoptosis) or paralysis (Horner syndrome) desensitises the mechanoreceptor of Müller's muscle, resulting in blepharoptosis. Shortening of the elongated and thinned Müller's muscle by instillation of phenylephrine, and surgical shortening, and fixation of the disinserted, elongated, and thinned aponeurosis using the orbital septum, restored involuntary tonic contraction of the levator muscle in nearly all of 2000 patients with aponeurotic blepharoptosis and in 11 patients with Horner syndrome.     

ANATOMICAL STUDY OF THE STRUCTURES AT THE ROOF OF THE ORBIT WITH SPECIAL REFERENCE TO THE CHECK LIGAMENT OF THE SUPERIOR FORNIX

In an attempt to clarify the topography of the structures at the roof of the orbit we dissected the anterior cranial fossas of seven cadavers. Structures such as the periorbita, levator muscle of the upper eyelid and its aponeurosis, as well as Tenon's capsule with its continuation into the check ligament of the superior fornix were identified. The technique for correction of congenital blepharoptosis by suspension of the check ligament of the superior fornix to the tarsus was mimicked and its function clarified.     

异体巩膜条悬吊术矫治重度上睑下垂

采用异体巩膜条悬吊矫治重度上睑下垂,共16例(22只眼)。重度上睑下垂12例,完全性上睑下垂4例,其中9例进行了长期随访。结果表明,8个月后的眼睑功能达到Fox提出的评定标准。对手术方法及术中悬吊高度调整等问题进行了讨论。     

中医古代文献关于眼睑下垂的认识源流

文章以证候描述和病因病机为主线,对中医古代文献中有关眼睑下垂的内容进行整理研究。通过以时间为轴梳理各时期的症状术语,笔者认为中医古籍关于眼睑下垂的证候描述存在着病变部位逐步明确,症状产生机制逐步明晰,症状描述渐趋详实3个趋势。而通过对该病论治内容的梳理,笔者认为关于眼睑下垂的病因病机,中医文献中出现过筋热驰缓,目纲失司,脾胃气虚,升阳无力,气血亏虚,风邪客睑3种主流认识。     

提睑肌切除额肌腱膜悬吊术治疗MarcusGunn上睑下垂

目的：介绍提睑肌切除,额肌腱膜悬吊术治疗ＭａｒｃｕｓＧｕｎｎ上睑下垂的手术。方法：通过两例ＭａｒｃｕｓＧｕｎｎ上睑下垂手术治疗报告了提睑肌切除,额肌腱膜悬吊术的方法。结果：术后随访上睑下矫正,ＭａｒｃｕｓＧ现象消失。结论：提睑肌切除额肌腱膜悬主治疗ＭａｒｃｕｓＧｕｎｎ上睑下垂的方法简单有铲。     

The Significance of Minimal Adjustments in the Muller’s Muscle and Conjunctiva Resection Procedure to Achieve the Phenylephrine Result

Purpose: To determine if adjusting the resection amount within a small range has a significant effect in the amount of lift achieved when performing the Muller’s muscle and conjunctiva resection procedure (MMCR).

Methods: A retrospective chart review was performed analyzing 102 eyelids of 68 patients with involutional blepharoptosis that had a MMCR resection amount ranging from 8.0–9.5?mm performed by a single surgeon (P.S.)

Results: The average lift for all resections was 2.30?mm. When comparing amongst all resection groups, there was no significant difference in the amount of lift obtained (p?=?0.2454).

Conclusion: When performing the MMCR procedure, adjusting the resection amount within a small range of 8.0–9.5?mm does not affect the amount of lift achieved.