Bangkok, Thailand.
From the Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society.
Plast Reconstr Surg. 2018 Feb;141(2):213e-219e. doi: 10.1097/PRS.0000000000004063.
The purpose of this study was to compare the efficacy of external levator advancement and Müller muscle-conjunctival resection in aponeurotic blepharoptosis repair.
Mild to moderate blepharoptosis patients with good levator function and a positive phenylephrine test were randomized to upper blepharoplasty with either external levator advancement or Müller muscle-conjunctival resection. The primary outcome was marginal reflex distance 1 at 1 month after surgery. Secondary outcomes were cosmetic outcome, complications, and operating room time.
Forty patients were enrolled, six men and 34 women, with an average age of 62.4 years. The mean preoperative marginal reflex distance 1 in the levator group (39 eyes/20 subjects) and the Müller group (38 eyes/20 subjects) was 1.2 ± 0.8 mm and 1.5 ± 0.7 mm, respectively. The mean postoperative marginal reflex distance 1 in the levator and Müller groups was 3.0 ± 1.0 mm and 3.2 ± 1.0 mm, respectively. The difference in the mean change was 0.008, and was not statistically different (95 percent CI, -0.59 to 0.61; p = 0.978). The mean cosmetic outcome was 2.69 ± 0.81 for the levator group and 3.07 ± 0.68 for the Müller group, with a mean difference of 0.373 (95 percent CI, 0.06 to 0.69; p = 0.020). The average operating room time was 75 ± 19.2 minutes for the levator group and 71 ± 23.6 minutes for the Müller group (p = 0.439). There were four eyes that underwent reoperation, three in the levator group (7.7 percent) and one in the Müller group (2.6 percent).
External elevator advancement and Müller muscle-conjunctival resection are both effective in correction of mild to moderate blepharoptosis. However, Müller muscle-conjunctival resection yields a statistically significant better cosmetic outcome and causes less eyelid asymmetry.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
本研究旨在比较外直肌前徙术和 Müler 肌皮瓣切除术治疗腱膜性上睑下垂的疗效。
轻度至中度腱膜性上睑下垂患者，提上睑肌功能良好，苯肾上腺素试验阳性，随机行上睑成形术，分别行外直肌前徙术或 Müler 肌皮瓣切除术。主要结局为术后 1 个月时的边缘反射距离 1。次要结局为美容效果、并发症和手术时间。
共纳入 40 例患者，其中男性 6 例，女性 34 例，平均年龄 62.4 岁。外直肌组（39 眼/20 例）和 Müler 组（38 眼/20 例）术前平均边缘反射距离 1 分别为 1.2±0.8mm 和 1.5±0.7mm。外直肌组和 Müler 组术后平均边缘反射距离 1 分别为 3.0±1.0mm 和 3.2±1.0mm，平均差值为 0.008，差异无统计学意义（95%置信区间，-0.59 至 0.61；p=0.978）。外直肌组美容效果评分为 2.69±0.81，Müler 组为 3.07±0.68，平均差值为 0.373（95%置信区间，0.06 至 0.69；p=0.020）。外直肌组手术时间平均为 75±19.2 分钟，Müler 组为 71±23.6 分钟（p=0.439）。4 只眼再次手术，外直肌组 3 只眼（7.7%），Müler 组 1 只眼（2.6%）。
外直肌前徙术和 Müler 肌皮瓣切除术治疗轻度至中度腱膜性上睑下垂均有效，但 Müler 肌皮瓣切除术在美容效果上有统计学意义的改善，且引起的眼睑不对称程度更小。
临床问题/证据水平：治疗性，II 级。
