Nemet Arie Y
Dr Nemet is the Director of Oculoplastic Service in the Department of Ophthalmology at the Meir Medical Center, Kfar Sava, Israel, a Senior Lecturer in the Sackler Medical School Tel Aviv University, Tel Aviv, Israel, and Chair of the Israeli Society of Ophthalmic Plastic and Reconstructive Surgery.
Aesthet Surg J. 2015 Sep;35(7):774-81. doi: 10.1093/asj/sjv052. Epub 2015 Apr 24.
The Hering's law effect has significant importance in surgical planning and outcomes of eyelid surgery.
The current study examined the preoperative and intraoperative effect of Hering's law in Mullerectomy and levator aponeurosis advancement.
A retrospective analysis was conducted of 52 patients with unilateral ptosis who underwent surgical repair from January 2011 through June 2013. Patients underwent levator aponeurosis advancement or Mullerectomy with or without tarsectomy. Preoperative and postoperative clinical documentation and photographs were evaluated. Preoperative Hering's dependency and postoperative changes in positioning of the non-operated eyelid were measured. The decision to operate on the ptotic eye alone or on both eyelids was based on preoperative Hering's dependence and intraoperative changes in the contralateral eyelid.
Fifty-two patients with unilateral ptosis were included. Average age was 63.3 ± 20.1 years (range, 22-88 years; median, 61 years); 34 (65.4%) were female. The 14 cases that were not aponeurotic (either congenital, secondary to trauma, or due to postoperative ptosis) did not need contralateral repair (p = .000). In 4 (19%) cases of Mullerectomy and in 9 (52.9%) cases of levator advancement, both eyelids required surgery (p = .029). Hering's law effect was significantly more apparent in the levator advancement approach than in Mullerectomy.
Levator surgery resulted in a higher incidence of combined intraoperative and postoperative Hering's law effect than did Mullerectomy. Cases with poor levator function or congenital ptosis can be repaired unilaterally with no need for contralateral surgery. The fibrotic levator palpebrae muscle and its special innervations probably explain this phenomenon. This should be considered in surgical planning.
赫林定律效应在眼睑手术的手术规划和结果中具有重要意义。
本研究探讨了赫林定律在 Müller 肌切除术和提上睑肌腱膜前移术中的术前和术中效应。
对2011年1月至2013年6月期间接受手术修复的52例单侧上睑下垂患者进行回顾性分析。患者接受提上睑肌腱膜前移术或 Müller 肌切除术，可联合或不联合睑板切除术。评估术前和术后的临床记录及照片。测量术前赫林定律依赖性以及未手术眼睑术后位置的变化。仅对患侧上睑下垂眼或双眼进行手术的决定基于术前赫林定律依赖性和对侧眼睑的术中变化。
纳入52例单侧上睑下垂患者。平均年龄为63.3±20.1岁（范围22 - 88岁；中位数61岁）；34例（65.4%）为女性。14例非腱膜性上睑下垂（先天性、外伤后或术后上睑下垂）患者无需对侧修复（p = 0.000）。在4例（19%）Müller 肌切除术和9例（52.9%）提上睑肌腱膜前移术中，双眼均需手术（p = 0.029）。赫林定律效应在提上睑肌腱膜前移术中比在 Müller 肌切除术中更明显。
提上睑肌手术导致术中及术后赫林定律效应的发生率高于 Müller 肌切除术。提上睑肌功能差或先天性上睑下垂的病例可单侧修复，无需对侧手术。提上睑肌纤维组织及其特殊神经支配可能解释了这一现象。在手术规划中应考虑这一点。
