Yamaguchi Kazuaki, Imai Keisuke, Fujimoto Takuya, Takahashi Makoto, Maruyama Yoko
From the Department of Plastic and Reconstructive Surgery, Osaka City General Hospital, Osaka, Japan.
Ann Plast Surg. 2015 Nov;75(5):518-21. doi: 10.1097/SAP.0000000000000198.
Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare, congenital, surgically challenging disease. We undertook an objective, functional, and cosmetic comparison between the modified Uchida procedure and the Mustarde procedure on Asian patients with BPES.
This is a retrospective, comparative, interventional case series with the description of 2 surgical techniques.
Twenty consecutive Japanese patients with BPES were studied.
The patients were assigned to either the modified Uchida or the Mustarde procedure on the basis of preoperative intercanthal distance (ICD) ratio (ICD/palpebral fissure width). Intercanthal distance and margin reflex distance were measured from photographs before and after surgery. Classifications were made according to epicanthal fold score and cosmetic score using a visual analog scale (VAS).
The main outcome measures were postoperative improvement in ICD ratio and the VAS.
Of the 20 patients, 5 underwent the modified Uchida procedure and the other 15 underwent the Mustarde procedure. The preoperative median ICD ratio was 2.0 (range, 1.9-2.5) and 2.5 (range, 2.0-3.4) for the modified Uchida and Mustarde procedures, respectively, and decreased to 1.5 (range, 1.5-1.7) and 1.6 (range, 1.5-1.8) postoperatively. The mean ICD reduction rate was 35.7% (SD, 1.0%) in the Mustarde group and 22.1% (SD, 1.3%) in the modified Uchida group (P < 0.001).The mean VAS for the modified Uchida and Mustarde procedures was 5.9 (SD, 1.3) and 2.8 (SD, 1.1), respectively, which was statistically significant (P = 0.0166).
Both the modified Uchida and Mustarde procedures could effectively shorten the ICD; however, cosmetic results were significantly superior using the modified Uchida method.
睑裂狭小-上睑下垂-内眦赘皮综合征（BPES）是一种罕见的先天性疾病，手术治疗具有挑战性。我们对亚洲BPES患者采用改良内田手术和马斯塔德手术进行了客观、功能和美容效果的比较。
这是一个回顾性、比较性、干预性病例系列，描述了两种手术技术。
连续纳入20例日本BPES患者进行研究。
根据术前内眦间距（ICD）与睑裂宽度比值（ICD/睑裂宽度）将患者分为改良内田手术组或马斯塔德手术组。通过手术前后照片测量内眦间距和边缘反射距离。使用视觉模拟量表（VAS）根据内眦赘皮评分和美容评分进行分类。
主要观察指标为术后ICD比值改善情况和VAS评分。
20例患者中，5例行改良内田手术，15例行马斯塔德手术。改良内田手术组和马斯塔德手术组术前ICD比值中位数分别为2.0（范围1.9 - 2.5）和2.5（范围2.0 - 3.4），术后分别降至1.5（范围1.5 - 1.7）和1.6（范围1.5 - 1.8）。马斯塔德手术组ICD平均降低率为35.7%（标准差1.0%），改良内田手术组为22.1%（标准差1.3%）（P < 0.001）。改良内田手术和马斯塔德手术的VAS评分平均值分别为5.9（标准差1.3）和2.8（标准差1.1），差异有统计学意义（P = 0.0166）。
改良内田手术和马斯塔德手术均可有效缩短ICD；然而，改良内田手术的美容效果显著更佳。
