Ulsan, South Korea; and Los Angeles, Calif. From the Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital; Dream Medical Group; and the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
Plast Reconstr Surg. 2014 Apr;133(4):887-896. doi: 10.1097/PRS.0000000000000011.
To create a more physiologic eyelid opening in patients with severe blepharoptosis, the authors used lamina propria mucosa of conjunctiva, which continues to the check ligament of the superior fornix, in addition to levator aponeurosis and Müller's muscle as a composite flap. In patients with epicanthal folds with associated telecanthus, the authors also performed epicanthoplasty with medial canthal tendon shortening.
Fifty blepharoptosis patients (85 eyelids) with a degree of ptosis of greater than 4 mm underwent the advancement technique using the levator aponeurosis-Müller's muscle-lamina propria mucosa of conjunctiva as a composite flap. Twenty-one (42 percent) of those patients also underwent split V-W epicanthoplasty and plication of the medial canthal tendon for epicanthal folds with associated telecanthus. Degree of ptosis and levator function were measured preoperatively and postoperatively.
Complete or near-complete correction of ptosis (degree of ptosis, <1 mm) was achieved in 54 eyelids (63.5 percent) and mild residual ptosis (degree of ptosis, 1 to 2 mm) was observed in 22 eyelids (25.9 percent) in postoperative follow-up after 6 months. The most common complication was reoperation, which was done in 15 eyelids (17.6 percent) because of incomplete correction.
The advancement technique using the levator aponeurosis- Müller's muscle-lamina propria mucosa of conjunctiva composite was effective in the treatment of severe blepharoptosis with levator function of 2 to 7 mm. The technique produced elevating motion of the physiologic eyelid in a superior-posterior direction. There were no serious complications, such as long-term lagophthalmos or lid lag.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
为了在严重上睑下垂的患者中实现更生理性的眼睑张开，作者使用了结合结膜的固有层粘膜，该粘膜延续至上穹窿的检查韧带，除了提上睑肌和 Müller 肌作为复合瓣。对于伴有内眦赘皮和相关内眦赘皮的患者，作者还进行了内眦腱缩短的内眦成形术。
50 例（85 只眼）上睑下垂程度大于 4 毫米的患者采用提上睑肌- Müller 肌-结膜固有层粘膜复合瓣的推进技术。其中 21 例（42%）患者还因内眦赘皮伴内眦赘皮和内眦赘皮，进行了 V-W 分裂内眦成形术和内眦腱缝合术。术前和术后测量上睑下垂程度和提上睑肌功能。
54 只眼（63.5%）完全或接近完全矫正上睑下垂（上睑下垂程度，<1 毫米），22 只眼（25.9%）观察到轻度残留上睑下垂（上睑下垂程度，1 至 2 毫米）在术后 6 个月的随访中。最常见的并发症是再手术，有 15 只眼（17.6%）因矫正不完全而再次手术。
使用提上睑肌- Müller 肌-结膜固有层粘膜复合瓣的推进技术对提上睑肌功能为 2 至 7 毫米的严重上睑下垂有效。该技术产生了生理性眼睑的向上向后提升运动。没有出现长期的睑裂闭合不全或眼睑迟滞等严重并发症。
临床问题/证据水平：治疗，IV。
