Whitehouse G M, Grigg J R, Martin F J
Children's Hospital, Sydney, Australia.
Aust N Z J Ophthalmol. 1995 Nov;23(4):309-14. doi: 10.1111/j.1442-9071.1995.tb00181.x.
To determine the visual and cosmetic outcome following the surgical correction of isolated congenital ptosis.
A retrospective review of the outcome of isolated congenital ptosis corrected under the supervision of one surgeon at The Children's Hospital, Camperdown, between January 1983 and January 1993 was examined. Some 65 patients with 80 involved eyes were identified; 30 eyes underwent a levator resection procedure, 40 eyes underwent a brow suspension using donor stored fascia lata, and in 10 eyes a brow suspension was performed using mersilene mesh.
In 78 eyes of 63 patients, a good cosmetic result was achieved. In two patients (two eyes) a poor cosmetic result was achieved. These two patients refused further surgery following an undercorrection of their initial ptosis. The recurrence rates for the primary procedures were 16.7% for levator resection procedures, 35% for brow suspension procedures using donor fascia lata, and 30% for brow suspension surgery using mersilene mesh. Some 35.3% of eyes following mersilene slings required further surgery for granulomas and exposed mersilene mesh compared with 6% having similar complications with stored fascia lata. Nine patients (11.25%) had reduced visual acuity (one line or more on the Snellen chart or its equivalent with the other tests used) on the operated side. Only one patient was found to have significant astigmatism.
An acceptable cosmetic result was achieved with one operation in 75.3% of cases. In 20.8% of cases a second operation was required and in 3.9% of cases three or more operations were required. This series supports the view that where possible, levator resection is the preferred form of surgery to correct congenital ptosis. When the levator function is inadequate, brow suspension is performed. The use of donor fascia lata resulted in a good cosmetic appearance with a low occurrence of surgical side effects. Amblyopia, when strictly defined, occurred in 11.25% of eyes despite early surgery for severe cases and intensive amblyopia therapy. Management requires repeated follow up for early detection and introduction of occlusion therapy or surgical ptosis correction.
确定孤立性先天性上睑下垂手术矫正后的视觉和美容效果。
对1983年1月至1993年1月间在坎珀当儿童医院由一名外科医生监督下矫正的孤立性先天性上睑下垂的结果进行回顾性研究。共确定了约65例患者的80只受累眼睛；30只眼睛接受了提上睑肌切除术，40只眼睛使用供体储存的阔筋膜进行了额肌悬吊术，10只眼睛使用涤纶网进行了额肌悬吊术。
63例患者的78只眼睛获得了良好的美容效果。2例患者（2只眼睛）美容效果不佳。这2例患者在初次上睑下垂矫正不足后拒绝进一步手术。初次手术的复发率为：提上睑肌切除术为16.7%，使用供体阔筋膜的额肌悬吊术为35%，使用涤纶网的额肌悬吊术为30%。使用涤纶吊带的眼睛中约35.3%因肉芽肿和涤纶网外露需要进一步手术，而使用储存阔筋膜出现类似并发症的比例为6%。9例患者（11.25%）患侧视力下降（在斯内伦视力表上下降一行或更多，或在使用的其他测试中相当于下降一行）。仅发现1例患者有明显散光。
75.3%的病例一次手术即可获得可接受的美容效果。20.8%的病例需要二次手术，3.9%的病例需要三次或更多次手术。本系列研究支持以下观点：在可能的情况下，提上睑肌切除术是矫正先天性上睑下垂的首选手术方式。当提上睑肌功能不足时，进行额肌悬吊术。使用供体阔筋膜可获得良好的美容外观，手术副作用发生率低。尽管对严重病例早期进行了手术并强化了弱视治疗，但严格定义的弱视仍发生在11.25%的眼睛中。管理需要反复随访，以便早期发现并引入遮盖疗法或手术矫正上睑下垂。
