Lee Ju-Hyang, Aryasit Orapan, Kim Yoon-Duck, Woo Kyung In, Lee Llewellyn, Johnson Owen N
Department of Ophthalmology, Ulsan University Hospital, Ulsan University School of Medicine, Ulsan, Korea.
Department of Ophthalmology, Hanyang University Graduate School of Medicine, Seoul, South Korea.
Br J Ophthalmol. 2017 Jun;101(6):740-746. doi: 10.1136/bjophthalmol-2016-309163. Epub 2016 Sep 6.
BACKGROUND/AIMS: Surgical treatments for the correction of congenital ptosis with poor levator function, including frontalis suspension or maximal levator resection, remain controversial. We evaluated the postoperative surgical and cosmetic outcomes after maximal levator resection for unilateral congenital ptosis with poor levator function.
A retrospective, interventional case series was performed. A total of 243 patients with 243 eyelids (210 unilateral and 33 bilateral asymmetric ptosis) who underwent unilateral maximal levator resection were included. The surgical results were graded as excellent, good and poor and postoperative complications were documented.
The mean age at the time of surgery was 8.8±9.7 years (range, 2-58 years) with mean follow-up time of 40.9±38.9 months (range, 3 months to 18.9 years). Satisfactory results (excellent or good result) were obtained in 93.0% of the patients. Patients were divided into two groups based on levator function as follows: 0-2 mm (80 cases) and 2.5-4.0 mm (163 cases). Factors such as preoperative levator function, margin reflex distance-1 and levator dehiscence were not correlated with postoperative surgical outcomes. Complications included exposure keratopathy (11.1%), lid crease asymmetry (8.2%), entropion (8.2%), overcorrection (3.3%), eyelash ptosis (3.7%), temporal eyelid droop (3.3%), suture abscess (0.8%) and conjunctival prolapse (0.8%).
Maximal levator resection is an effective procedure for congenital ptosis even in patients with poor levator function, which provides improved cosmesis, a more natural lid contour, and avoids brow scars.
背景/目的：用于矫正提上睑肌功能不良的先天性上睑下垂的手术治疗方法，包括额肌悬吊术或最大提上睑肌切除术，仍存在争议。我们评估了最大提上睑肌切除术治疗单侧先天性上睑下垂伴提上睑肌功能不良的术后手术效果和美容效果。
进行了一项回顾性干预性病例系列研究。纳入了243例接受单侧最大提上睑肌切除术的患者，共243只眼睑（210例单侧和33例双侧不对称上睑下垂）。手术结果分为优、良和差，并记录术后并发症。
手术时的平均年龄为8.8±9.7岁（范围2至58岁），平均随访时间为40.9±38.9个月（范围3个月至18.9年）。93.0%的患者获得了满意的结果（优或良）。根据提上睑肌功能将患者分为两组：0至2毫米（80例）和2.5至4.0毫米（163例）。术前提上睑肌功能、边缘反射距离-1和提上睑肌裂开等因素与术后手术效果无关。并发症包括暴露性角膜病变（11.1%）、睑裂不对称（8.日）、睑内翻（8.2%）、矫正过度（3.3%）、睫毛下垂（3.7%）、颞侧眼睑下垂（3.3%）、缝线脓肿（0.8%）和结膜脱垂（0.8%）。
最大提上睑肌切除术即使对于提上睑肌功能不良的患者也是治疗先天性上睑下垂的有效方法，可改善美容效果，使眼睑轮廓更自然，并避免眉部瘢痕。
