Erb Melanie H, Kersten Robert C, Yip Chee-Chew, Hudak Donald, Kulwin Dwight R, McCulley Timothy J
University of California at Irvine College of Medicine, Department of Ophthalmology, Irvine, California, USA.
Ophthalmic Plast Reconstr Surg. 2004 Nov;20(6):418-22. doi: 10.1097/01.iop.0000143714.10858.d4.
This study evaluates the effect of unilateral blepharoptosis repair on contralateral eyelid position and assesses the relation between preoperative eyelid height interdependence, consistent with Hering law, and surgical outcome.
The medical records of 54 patients (21 men, 33 women; mean age, 65 years) who underwent external levator advancement for unilateral aponeurotic blepharoptosis were reviewed for preoperative and postoperative margin reflex distance (MRD) of the nonoperated eye. To assess the relation between preoperative Hering dependence (mechanical elevation of the ptotic eyelid causing a decrease in contralateral eyelid height) and postoperative eyelid position, the change in MRD of the nonoperated eye was compared between subjects who on preoperative evaluation did (n=18) and did not (n=36) demonstrate eyelid height interdependence, using the 2-sample t test.
After unilateral blepharoptosis repair, the mean (+/- SD) change in contralateral MRD was -0.2 +/- 0.8 mm. There was no significant difference in contralateral MRD change in subjects with and without preoperative Hering dependence (-0.3 +/- 0.8 mm versus -0.2 +/- 0.9 mm, respectively, p=0.78). Seventeen percent (9 of 54) of patients had a contralateral MRD decrease of more than 1 mm. Three patients (5.6%) required contralateral blepharoptosis repair within 1 year of initial surgery.
After levator advancement for unilateral blepharoptosis, roughly 17% of patients will have a decrease in contralateral eyelid height of more than 1 mm, with 5% of patients requiring surgical repair during the first postoperative year. The degree of change in contralateral eyelid height cannot be reliably predicted by preoperative assessment of Hering dependence.
本研究评估单侧上睑下垂修复术对侧眼睑位置的影响，并评估术前符合赫林定律的眼睑高度相互依存关系与手术结果之间的关联。
回顾了54例（21例男性，33例女性；平均年龄65岁）因单侧腱膜性上睑下垂接受外路提上睑肌缩短术患者的病历，记录术眼和非术眼术前及术后的边缘反射距离（MRD）。为评估术前赫林依存性（下垂眼睑的机械性抬高导致对侧眼睑高度降低）与术后眼睑位置之间的关系，采用两样本t检验，比较术前评估显示（n = 18）和未显示（n = 36）眼睑高度相互依存关系的受试者非术眼MRD的变化。
单侧上睑下垂修复术后，对侧MRD的平均（±标准差）变化为-0.2±0.8 mm。术前有和没有赫林依存性的受试者对侧MRD变化无显著差异（分别为-0.3±0.8 mm和-0.2±0.9 mm，p = 0.78）。17%（54例中的9例）的患者对侧MRD降低超过1 mm。3例患者（5.6%）在初次手术后1年内需要进行对侧上睑下垂修复。
单侧上睑下垂提上睑肌缩短术后，约17%的患者对侧眼睑高度降低超过1 mm，5%的患者在术后第一年需要手术修复。术前对赫林依存性的评估不能可靠地预测对侧眼睑高度的变化程度。
