Gazzola Riccardo, Piozzi Elena, Vaienti Luca, Wilhelm Baruffaldi Preis Franz
a Plastic Surgery Department, Policlinico di Monza , Monza , Italy.
b Pediatric Ophtalmology Department , Ospedale Niguarda Cà Granda , Milan , Italy.
Semin Ophthalmol. 2018;33(4):454-460. doi: 10.1080/08820538.2017.1297840. Epub 2017 Mar 15.
Several treatments have been described for the treatment of congenital ptosis, but there are few studies that analyze the effectiveness of a therapeutic approach rather than a single technique.
In this study, we aim to evaluate the effectiveness of our therapeutic algorithm, which relies on levator muscle resection and frontalis suspension with silicone rods, polytetrafluoroethylene (PTFE), or autologous fascia lata.
We retrospectively analyzed all patients affected by congenital ptosis who underwent corrective surgery at a single department between January 1998 and January 2016.
A total of 116 procedures were performed in 86 patients, accounting for 35 levator resections, 67 frontalis suspensions, and 14 revisions. A satisfactory result was observed in 65 cases after one procedure (75.6%). Complications occurred in 13 cases after primary surgery (15.1%). Ptosis relapse was observed in 25 cases after primary procedure (21.5%). Frontalis suspension displayed a higher number of complications than levator resection (22.2% vs 3.1%, p=0.02).
Our therapeutic algorithm was effective in 75.6% after one procedure. Frontalis suspension procedures encountered a higher rate of complication than levator resection. Fascia lata should be preferred to silicon rods whenever possible due to the lower recurrence rate. These issues confirm the therapeutic algorithm, although larger prospective studies are necessary to validate our approach.
已有多种治疗先天性上睑下垂的方法被描述，但很少有研究分析一种治疗方法而非单一技术的有效性。
在本研究中，我们旨在评估我们的治疗方案的有效性，该方案依赖于提上睑肌切除术以及使用硅胶棒、聚四氟乙烯（PTFE）或自体阔筋膜进行额肌悬吊术。
我们回顾性分析了1998年1月至2016年1月期间在单一科室接受矫正手术的所有先天性上睑下垂患者。
86例患者共进行了116次手术，其中包括35次提上睑肌切除术、67次额肌悬吊术和14次修复手术。一次手术后65例患者取得了满意的效果（75.6%）。初次手术后13例患者出现并发症（15.1%）。初次手术后25例患者出现上睑下垂复发（21.5%）。额肌悬吊术的并发症数量高于提上睑肌切除术（22.2%对3.1%，p = 0.02）。
我们的治疗方案一次手术后的有效率为75.6%。额肌悬吊术的并发症发生率高于提上睑肌切除术。由于复发率较低，应尽可能优先选用阔筋膜而非硅胶棒。这些问题证实了该治疗方案，尽管需要更大规模的前瞻性研究来验证我们的方法。
