Bagheri Abbas, Ahadi Hashem, Babsharif Babak, Salour Hossein, Yazdani Shahin
Department of Ophthalmology, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Orbit. 2012 Feb;31(1):48-52. doi: 10.3109/01676830.2011.605502. Epub 2011 Dec 1.
To report the outcomes of ptosis surgery in patients with weak levator function utilizing the direct tarsus to frontalis muscle sling technique without creation of a flap.
In a prospective nonrandomized case series over a 3-year period, patients with ptosis and weak (less than 4 mm) levator function underwent direct sling of the tarsus to frontalis muscle without creating any flap. Success was defined as upper lid margin to central corneal reflex distance of at least 3 mm in bilateral cases and a difference of less than 1 mm in unilateral cases.
Overall, 26 eyes of 22 patients with mean age of 15.4 ± 9.4 years were operated and followed up for 13.5 ± 8.4 months. The ptosis was congenital in 15 patients (68.2%) and acquired in 7 patients (31.8%). Twelve patients (54.5%) had a history of ptosis surgery. The procedure was judged as successful in 77.3% of patients after initial surgery and in 100% after reoperation. Surgical success after initial surgery was directly correlated with the amount of levator function (P = 0.02). However, success was not associated with age (P = 0.9) or history of surgery (P = 0.9). None of the patients developed eyelid hematoma, lagophthalmus or dry eye.
Direct sling of the upper tarsus to the frontalis muscle without creation of flap is an effective procedure for correction of ptosis in patients with weak levator function. Minimal dissection and preservation of the orbicularis oculi prevents lagophthalmus and its consequences.
报告采用直接睑板至额肌吊带技术（不制作皮瓣）治疗提上睑肌功能薄弱患者上睑下垂手术的效果。
在一项为期3年的前瞻性非随机病例系列研究中，对上睑下垂且提上睑肌功能薄弱（小于4毫米）的患者进行直接睑板至额肌吊带手术，不制作任何皮瓣。成功的定义为双侧病例中，上睑缘至中央角膜反射距离至少为3毫米；单侧病例中，差异小于1毫米。
总体而言，22例患者的26只眼接受了手术，平均年龄为15.4±9.4岁，随访时间为13.5±8.4个月。上睑下垂为先天性的患者有15例（68.2%），后天性的有7例（31.8%）。12例患者（54.5%）有上睑下垂手术史。初次手术后，77.3%的患者手术被判定为成功，再次手术后成功率为100%。初次手术后的手术成功率与提上睑肌功能量直接相关（P = 0.02）。然而，成功率与年龄（P = 0.9）或手术史（P = 0.9）无关。所有患者均未出现眼睑血肿、兔眼或干眼。
直接将上睑板悬吊至额肌而不制作皮瓣是治疗提上睑肌功能薄弱患者上睑下垂的有效方法。最小限度的解剖和保留眼轮匝肌可预防兔眼及其后果。
