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）

Modified shortening of levator palpebrae superioris for the treatment of severe congenital ptosis in adults

Objective  To investigate the feasibility and efficacy of modified shortening of levator palpebrae superioris muscle for treatment of severe congenital adulthood blepharoptosis. Design Retrospective case series. Participants Twenty-seven cases (36 eyes) of severe congenital ptosis in adults. Methods Charts of consecutive 27 patients, 18 to 45-year old, with severe congenital ptosis, presented from January 2013 to December 2014 were retrospectively reviewed. The patients underwent a modified shortening of levator palpebrae superioris surgery to correct ptosis, and were followed at postoperative 1 year. Clinical efficacy was observed. The evaluation standards were as following. (1) Satisfaction：the upper eyelid margin was 1~2 mm below the upper edge of the cornea and palpebral margin curves naturally without complications; (2) Over-straightening: the position of upper eyelid margin was above the cornea margin; (3) Undercorrection: the upper eyelid margin covered up to 1/3 of the pupil; (4) Recurrence: the upper eyelid margin occluded more than 1/3 pupil. Main Outcome Measures The eyelid position, eyelid curvature and complications (entropion, conjunctival prolapse, exposure keratitis) recorded at the 1 year follow-up visit. Results Twenty-two cases (31 eyes) showed satisfactory correction. One eye showed entropion. Two showed conjunctival prolapse and 2 eyes showed undercorrection. Conclusions Our modified levator muscle resection is effective and safe for treatment of severe adult congenital ptosis in one year. (Ophthalmol CHN, 2018, 27: 362-365)