Ho Yeen-Fey, Wu Shu-Ya, Tsai Yueh-Ju
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, and the College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, and the College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Am J Ophthalmol. 2017 Mar;175:173-182. doi: 10.1016/j.ajo.2016.12.013. Epub 2016 Dec 28.
To evaluate the 10-year results of surgery for congenital ptosis and identify factors associated with excellent outcomes and recurrence.
Retrospective, interventional case series.
A retrospective analysis was conducted of 319 patients who underwent surgical correction at a tertiary medical center for congenital ptosis. The main outcome measures were postoperative surgical outcomes and recurrence rates. Excellent lid height was assessed as a marginal reflex distance (MRD) greater than 3 mm. Recurrence was defined as a lid height less than 50% of the initial postoperative lid height.
The overall surgical success rate was 97.2%. On multivariate analysis, 3 factors were significantly associated with a greater probability of achieving excellent lid height: treatment using levator muscle resection (LMR) (adjusted odds ratio [OR], 1.76; P = .04), better preoperative MRD (adjusted OR, 2.21; P < .001), and absence of Marcus Gunn (jaw-winking) syndrome (adjusted OR, 0.12; P = .01). For recurrence, 7 significant risk factors were identified: children less than 1 year old (adjusted OR, 4.92; P = .02), poorer preoperative MRD (adjusted OR, 0.64; P = .04), poorer postoperative MRD (adjusted OR, 0.32; P < .001), treatment with frontalis suspension (FS) (adjusted OR, 5.86; P < .001), wound infection (adjusted OR, 9.45; P = .02), postoperative entropion (adjusted OR, 11.25; P = .003), and conjunctival prolapse (adjusted OR, 7.10; P = .03). Kaplan-Meier analysis showed that the 1-, 5-, and 10-year recurrence-free rates were 97.3% ± 1.2%, 80.5% ± 4.4%, and 76.7% ± 5.6%, respectively, for the LMR group and 90.9% ± 3.1%, 42.9% ± 8.1%, and 20.8% ± 10.1%, respectively, for the FS group (P < .001, log-rank test).
Surgical treatment of congenital ptosis had a high success rate. Identifying the risk factors and taking appropriate measures may result in better surgical outcomes and less recurrence. Our retrospective study showed that the likelihood of achieving excellent outcomes with lower recurrence rates was higher with LMR than with FS. However, a prospective randomized study is necessary to clarify their efficacy.
评估先天性上睑下垂手术的10年疗效，并确定与良好预后和复发相关的因素。
回顾性干预病例系列研究。
对在一家三级医疗中心接受先天性上睑下垂手术矫正的319例患者进行回顾性分析。主要结局指标为术后手术效果和复发率。上睑高度良好定义为边缘反射距离（MRD）大于3毫米。复发定义为上睑高度小于术后初始上睑高度的50%。
总体手术成功率为97.2%。多因素分析显示，3个因素与获得良好上睑高度的可能性显著相关：采用提上睑肌切除术（LMR）治疗（调整后的优势比[OR]，1.76；P = .04）、术前MRD较好（调整后的OR，2.21；P < .001）以及无Marcus Gunn（下颌瞬目）综合征（调整后的OR，0.12；P = .01）。对于复发，确定了7个显著危险因素：1岁以下儿童（调整后的OR，4.92；P = .02）、术前MRD较差（调整后的OR，0.64；P = .04）、术后MRD较差（调整后的OR，0.32；P < .001）、采用额肌悬吊术（FS）治疗（调整后的OR，5.86；P < .001）、伤口感染（调整后的OR，9.45；P = .02）、术后睑内翻（调整后的OR，11.25；P = .003）和结膜脱垂（调整后的OR，7.10；P = .03）。Kaplan-Meier分析显示，LMR组的1年、5年和10年无复发生存率分别为97.3%±1.2%、80.5%±4.4%和76.7%±5.6%，FS组分别为90.9%±3.1%、42.9%±8.1%和20.8%±10.1%（P < .001，对数秩检验）。
先天性上睑下垂的手术治疗成功率较高。识别危险因素并采取适当措施可能会带来更好的手术效果和更低的复发率。我们的回顾性研究表明，LMR比FS获得良好预后且复发率更低的可能性更高。然而，需要进行前瞻性随机研究以阐明它们的疗效。
