Clark Thomas J E, Klejch Wesley J, Wang Kai, Allen Richard C, Nerad Jeffrey A, Carter Keith D, Shriver Erin M
Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa.
Carver College of Medicine, University of Iowa, Iowa City, Iowa.
Ophthalmic Plast Reconstr Surg. 2018 May/Jun;34(3):284-290. doi: 10.1097/IOP.0000000000000951.
To determine the applicability and clinical relevance of Hering's law for the eyelids in cases of congenital ptosis.
A retrospective chart review and digital photograph analysis of patients who underwent unilateral congenital ptosis repair at a tertiary, university-based, Oculoplastics clinic was conducted. Pre- and postoperative eyelid height (marginal reflex distance), upper eyelid symmetry, and brow position were determined using ImageJ analysis software. Changes in these values, and the relationship between the change in ipsi- and contralateral eyelid heights and brow positions, were determined.
In 51 patients, the mean change in contralateral upper eyelid position (marginal reflex distance) following unilateral repair was -0.5 mm with 29% (n = 15) demonstrating a greater than 1 mm contralateral descent. The contralateral brow position remained stable with a mean change of +0.1 mm. No significant differences were seen between the 15 patients who demonstrated a contralateral upper eyelid descent greater than 1 mm and the remainder of the cohort in terms of amblyopia rate (p = 0.71), mean preoperative marginal reflex distance (p = 0.14), mean change in ipsilateral marginal reflex distance (p = 0.32), mean change in contralateral brow position (p = 0.44), or mean postoperative upper eyelid asymmetry (1.3 mm vs. 1.2 mm). Overall, the mean upper eyelid asymmetry improved from 2.6 mm preoperatively to 1.2 mm postoperatively. None of the 51 patients underwent subsequent contralateral ptosis repair.
Hering's law for the eyelids applies to cases of congenital ptosis but has little clinical significance due to improved upper eyelid asymmetry following unilateral surgery.
确定赫林定律在先天性上睑下垂病例中对眼睑的适用性及临床相关性。
对在一所大学附属三级眼科整形诊所接受单侧先天性上睑下垂修复手术的患者进行回顾性病历审查和数码照片分析。使用ImageJ分析软件确定术前和术后的眼睑高度（边缘反射距离）、上睑对称性及眉位。确定这些数值的变化，以及同侧和对侧眼睑高度及眉位变化之间的关系。
51例患者中，单侧修复术后对侧上睑位置（边缘反射距离）的平均变化为-0.5毫米，29%（n = 15）的患者对侧下降超过1毫米。对侧眉位保持稳定，平均变化为+0.1毫米。在弱视发生率（p = 0.71）、术前平均边缘反射距离（p = 0.14）、同侧边缘反射距离的平均变化（p = 0.32）、对侧眉位的平均变化（p = 0.44）或术后上睑平均不对称度（1.3毫米对1.2毫米）方面，15例对侧上睑下降超过1毫米的患者与其余患者之间未观察到显著差异。总体而言，上睑平均不对称度从术前的2.6毫米改善至术后的1.2毫米。51例患者中无一例随后接受对侧上睑下垂修复。
眼睑的赫林定律适用于先天性上睑下垂病例，但由于单侧手术后上睑不对称度得到改善，其临床意义不大。
