Kartush J M, Linstrom C J, McCann P M, Graham M D
Michigan Ear Institute, Farmington Hill 48334.
Otolaryngol Head Neck Surg. 1990 Dec;103(6):1016-23. doi: 10.1177/019459989010300622.
Facial paralysis can result in serious keratopathy because of corneal exposure and inadequate lacrimation. Thirty-seven patients underwent thirty-eight gold weight upper lid implants to rehabilitate paralysis of the eyelid from various causes. When indicated, implantation was combined with lower lid ectropion repair, medial canthoplasty or brow lift. Because of encouraging results in patients with longstanding facial paralysis, "early" implantation (within 1 month of paralysis) was offered to patients with severe lagophthalmos in whom (1) a severe neural injury was documented at the time of transtemporal surgery or (2) delayed, incomplete return of function was expected. Gold weight implantation resulted in excellent eyelid closure, protection, and cosmesis. There were no infections or extrusions. Lagophthalmos and exposure keratitis resolved or were significantly improved in all patients, and most were able to dispense with eyedrops and salves. Visual acuity improved in 95% of patients--a benefit even those without preoperative keratitis often achieved. A mild worsening of one patient's pre-existing astigmatism developed, which resolved after reimplantation with a lighter weight. The implant is easily removed from those patients who, having undergone early implantation, eventually recover adequate function. Gold weight loading has become our procedure of choice for eyelid rehabilitation.
面瘫可因角膜暴露和泪液分泌不足导致严重的角膜病变。37例患者接受了38次金重上睑植入术，以修复各种原因引起的眼睑麻痹。必要时，植入术可与下睑外翻修复术、内眦成形术或提眉术联合进行。鉴于长期面瘫患者取得了令人鼓舞的效果，对于重度兔眼患者，若出现以下情况，则建议“早期”植入（面瘫后1个月内）：（1）经颞部手术时记录有严重神经损伤；（2）预期功能恢复延迟或不完全。金重植入术可实现极佳的眼睑闭合、保护及美容效果。未出现感染或植入物脱出情况。所有患者的兔眼和暴露性角膜炎均得到缓解或显著改善，大多数患者无需再使用眼药水和药膏。95%的患者视力得到改善，即使术前无角膜炎的患者也常能从中获益。1例患者原有的散光轻度加重，更换较轻重量的植入物后散光消失。对于早期植入后最终恢复足够功能的患者，植入物易于取出。金重植入已成为我们进行眼睑修复的首选术式。
