Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Am J Ophthalmol. 2013 Feb;155(2):397-403.e1. doi: 10.1016/j.ajo.2012.08.006. Epub 2012 Oct 27.
To compare outcomes of conjunctival Müllerectomy with or without tarsectomy versus external levator advancement for correction of upper blepharoptosis when performed by trainee versus staff surgeons.
Retrospective, nonrandomized, interventional, consecutive case series.
Charts of patients undergoing conjunctival Müllerectomy with or without tarsectomy and external levator advancement blepharoptosis repair from January 2006 through December 2009 were reviewed. Main outcome measures included age, gender, preoperative and postoperative use of artificial tears, preoperative and postoperative marginal reflex distance, surgical complications, surgeon (trainee or staff surgeon), and anesthesia time. The Student t test was used for statistical analysis.
A total of 170 patients underwent 248 surgeries (154 conjunctival Müllerectomies with or without tarsectomy and 94 external levator advancements). There were 108 female and 62 male patients. Mean patient age was 62 years (range, 3 to 94 years). Forty-one (24%) patients (26 conjunctival Müllerectomies with or without tarsectomy and 15 external levator advancements) underwent concurrent eyelid surgery, such as blepharoplasty. Trainees performed surgery on a total of 88 (35%) eyelids in 60 patients (35%). There was no significant difference in the percentage of cases undergoing concomitant surgery between trainee and staff surgeons (P = .18). The mean postoperative marginal reflex distance difference was 0.53 and 0.59 for trainee and staff surgeons, respectively. Mean overall anesthesia time was 26.8 minutes and 30.3 minutes for trainee and staff surgeons, respectively. Complications, including increase in dry eye or irritative symptoms and reoperation, occurred in 8 (13%) of 60 patients undergoing surgery by a trainee surgeon and in 22 (20%) of 110 patients undergoing surgery by staff surgeon. There was no significant difference in eyelid symmetry (P = .55), mean anesthesia time (P = .14), complication rate (P = .26), or reoperation rate (P = .17) when surgery was performed by a trainee versus a staff surgeon.
There is no significant difference in mean postoperative marginal reflex distance, mean anesthesia time, complication rate, or reoperation rate between either conjunctival Müllerectomy with or without tarsectomy or external levator advancement blepharoptosis repair performed by trainee versus staff surgeons.
比较由受训医师和主治医生施行的结膜 Müller 切除术联合或不联合腱膜切除术与外直肌前徙术治疗上睑下垂的疗效。
回顾性、非随机、介入性、连续病例系列研究。
对 2006 年 1 月至 2009 年 12 月期间行结膜 Müller 切除术联合或不联合腱膜切除术与外直肌前徙术治疗上睑下垂的患者的病历进行回顾性分析。主要观察指标包括年龄、性别、术前和术后人工泪液的使用、术前和术后的边缘反射距离、手术并发症、手术医生（受训医师或主治医生）和麻醉时间。采用 Student t 检验进行统计学分析。
共 170 例患者（154 例行结膜 Müller 切除术联合或不联合腱膜切除术，94 例行外直肌前徙术）接受了 248 次手术。其中女性 108 例，男性 62 例。患者平均年龄为 62 岁（3~94 岁）。41 例（24%）患者（26 例行结膜 Müller 切除术联合或不联合腱膜切除术，15 例行外直肌前徙术）同时行眼睑手术，如重睑术。受训医师共对 60 例患者（35%）的 88 只眼（35%）进行了手术。受训医师和主治医生施行联合手术的比例差异无统计学意义（P=0.18）。受训医师和主治医生的术后平均边缘反射距离差值分别为 0.53 和 0.59。受训医师和主治医生的平均总麻醉时间分别为 26.8 分钟和 30.3 分钟。8 例（13%）由受训医师施行手术的患者和 22 例（20%）由主治医生施行手术的患者出现了干眼症或刺激性症状加重和再次手术等并发症。受训医师和主治医生施行手术的患者在眼睑对称性（P=0.55）、平均麻醉时间（P=0.14）、并发症发生率（P=0.26）或再次手术率（P=0.17）方面差异均无统计学意义。
受训医师和主治医生施行结膜 Müller 切除术联合或不联合腱膜切除术与外直肌前徙术治疗上睑下垂的术后平均边缘反射距离、平均麻醉时间、并发症发生率和再次手术率差异均无统计学意义。
