Surgical Outcomes of Unilateral Marcus Gunn Jaw Winking Ptosis Correction: A Novel Whitnall’s Ligament Approach

PurposeTo evaluate the surgical, functional, and cosmetic outcome in moderate to severe ptosis with Marcus Gunn jaw winking phenomenon and recurrence of disease after ptosis correction. This procedure has been emphasized on a child.MethodsThis was a prospective, non-comparative, interventional study conducted over 4 years on 30 people. The ages range from 7 to 40 years. The eyelid was approached from behind to identify the Whitnall’s ligament. Levator palpebrae superioris was first disinserted then dissected up to the superior border of the tarsal plate followed by 20 to 25 mm by resection which causes disabling of the levator palpebrae superioris action. Subsequently, “tarso frontalis sling with silicon rod” for ptosis correction. Compared with the preoperative and postoperative photograph.ResultsMargin reflex distance 1 values are in the affected eye preoperative 1.8 ± 0.87 mm to postoperative 3.96 ± 0.41 mm. Preoperative palpebral fissure height are means 5.05 ± 0.62 mm to postoperative palpebral fissure height means 9.3 ± 0.71 mm. Ptosis significantly improved which is statistically significant (p < 0.05). Lid excursion or Flickering’s in affected eyes preoperative means 6.1 ± 3.47 mm to postoperative after 1 year means are 0.43 ± 0.81 mm. Follow-up period is 1 year.ConclusionsUnilateral posterior approach (Whitnall’s ligament approach) is found better in surgical, functional, and cosmetic outcomes in the correction of Marcus Gunn jaw winking syndrome, especially in children. The risk of bilateral extensive surgery is avoided. After the surgery, the primary gaze face photo identity was well-accepted in official government documents. This study is stressed on bilateral lid height similarity in primary gaze unlike the traditional method of downgaze similarities. The patients were highly satisfied both physically and mentally.     

改良Park法重睑成形术治疗轻度上睑下垂的临床效果

探讨改良Park法重睑成形术治疗轻度上睑下垂的临床效果。方法 选取北京原力医疗美 容诊所2018年1月-2022年12月收治的52例轻度上睑下垂患者为研究对象，随机分为对照组与观察组， 每组26例。对照组接受传统上睑下垂矫正术治疗，观察组接受改良Park法重睑成形术治疗，比较两组睑 裂指标、重睑效果及并发症发生情况。结果 两组术后睑裂高度高于术前（P ＜0.05），观察组高于对 照组，但差异无统计学意义（P ＞0.05）；两组术后睑裂宽度低于术前（P ＜0.05），观察组低于对照 组，但差异无统计学意义（P ＞0.05）；两组术后重睑形态、双侧重睑对称、眼睑恢复情况评分及总评 分高于术前，且观察组高于对照组（P ＜0.05）；观察组并发症发生率为3.85%，低于对照组的30.77% （P＜0.05）。结论 采用改良Park法重睑成形术治疗轻度上睑下垂可有效改善睑裂情况，重睑效果较佳，同 时可减少并发症发生几率，安全性较高。     

额肌动力上睑SMAS提紧治疗上睑下垂方法研究

目的:研究重度上睑下垂的动力选择、上睑提升传动结构再造、传动方向设置和再造动力的起止点。方法:根据多年临床实践及尸体解剖研究，以治疗2例家族性先天肌原性上睑下垂的过程，确定额肌作为上睑动力的解剖结构的命名；动力源滑车设计，动力传动组织结构；动力传布的方向；动力源额肌瓣的起点和止点设计，以及动力源额肌瓣的长宽设计等。结果:以额肌作为动力，额骨眶上缘作为滑车，上睑SMAS瓣为动力传动组织结构，取宽12～15mm，长15～20mm的长方形额肌上睑SMAS瓣，置于眼轮匝肌后方。眶缘上1cm额肌和SMAS结合处，作为上睑动力源的起点，上睑睑板上1／3，为再造上睑动力的止点。修复后静态时，使矫正的上睑缘高于健侧1～2mm，即位于角膜上缘，或角膜上缘1mm。2例患者手术治疗后功能和外形得到改善。结论:额肌上睑SMAS提紧是治疗先天性重度上睑下垂和复发性上睑下垂的良好方法，手术操作简便。再造动力功能良好。     

额肌瓣转移悬吊术矫治重度上睑下垂

目的 观察额肌瓣转移悬吊术矫治重度上睑下垂的治疗效果。方法 对36例41眼先天性重度上睑下垂采用上睑皮肤双切口，分离额肌瓣，经眶隔和眠轮匝肌之间的隧道向下转移，固定在上睑板上缘。结果 随访6月～7年。全部病例达标准治愈。结论 该术式为矫治具有额肌功能的任何上睑下垂，特别是重度上睑下垂的最佳手术方式。     

Tear function and ocular surface after muller muscle- conjunctival resection

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function.     

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.     

调跷脉治疗上睑下垂40例

目的：比较调跷脉针刺法与常规针刺法治疗上睑下垂的临床疗效。方法：将80例上睑下垂患者随机分为调跷脉治疗组和常规对照组,每组各40例。调跷脉治疗组采用调跷脉针刺法治疗,取风府、照海、申脉、跗阳、交信;常规对照组采用常规针刺治疗,取风池、攒竹、丝竹空、阳白、三阴交等穴,两组均治疗10次为1个疗程,共治疗3个疗程。结果：调跷脉治疗组和常规对照组有效率分别为92.5%和70%,调跷脉治疗组明显优于常规对照组（P〈0.01）;治疗后两组患者睑裂均增宽,但调跷脉治疗组为优（P〈0.05）。结论：调跷脉治疗上睑下垂疗效肯定,值得进一步研究和临床推广。     

Timing of surgical correction for the treatment of unilateral congenital ptosis: Effects on cosmetic and functional results

The authors analyzed the cosmetic and functional results of a series of patients with unilateral congenital ptosis who underwent levator resection, to compare the outcome of surgery according to the age of intervention, and to evaluate the chance of ptosis recurrence in different age groups. Analysis of the clinical charts of 44 patients who underwent a unilateral levator muscle resection under the care of one surgeon from February 2000 to March 2012 was performed. Age at the time of surgery ranged from 2.1 to 12 years. The study population was divided into different groups according to the age of surgery. Preoperative evaluation included measurements of upper eyelid margin reflex distance (MRD1), levator function, frontalis function, and complete extraocular motility examination. This study adheres to the principles outlined in the Declaration of Helsinki. The patients’ follow-up ranged between 2 and 12 years. The outcome of surgery was more satisfactory (MRD1 increase: p < 0.002) and the increase of levator function was better (p < 0.0001) when surgery was performed in children aged 2 to 4 years. No ptosis recurrence was observed in children aged 2 to 4 years, as opposed to 6 (22%) children of other groups (p = 0.067). Unilateral levator resection effectively reduces the asymmetry between eyelids. The age of the operation appears to influence the outcome of surgery, as in this series cosmetic and functional results are better and the rate of ptosis recurrence is lower if the child is operated on before the age of 4 years.     

不对称双侧先天性上睑下垂的分期手术治疗策略

目的 探讨不对称的先天性双侧上睑下垂进行分期手术的治疗策略。方法 对2011年至2013年的30例不对称双侧上睑下垂患者进行分期手术矫正。一期手术矫正较重侧(中~重度),行睑板部分切除联合上睑提肌缩短前徙术;3~6个月后再行较轻侧矫正,行睑板部分切除术或上睑提肌缩短术。术后随访3~24个月,术后评估内容包括矫正程度与双侧对称性。结果 全部30例患者60只眼,在矫正效果评估中,37(61.7%)只眼为充分矫正,23(38.3%)只眼为中等矫正,无矫正不足或过矫病例。对称性评估中,23(76.5%)例达到良好对称,7(23.5%)例达到中等对称,无对称不佳病例。结论 与我们以往的治疗经验相比,对于不对称的双侧先天性上睑下垂,分期手术治疗能够达到更好的对称效果。