Baccega Adriano, Garcia Denny Marcos, Velasco Cruz Antonio Augusto
a Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , São Paulo , Brazil.
b Craniofacial Research Support Center , University of São Paulo , Ribeirão Preto , São Paulo , Brazil.
Curr Eye Res. 2018 Aug;43(8):981-985. doi: 10.1080/02713683.2018.1467934. Epub 2018 May 1.
To measure the long-term effects of frontalis slings with fascial tissues on the downward eyelid saccadic movements Methods: Downward lid saccades for 10, 20, 30, 40, and 50 degrees of downgaze were measured in a sample of 19 patients with congenital ptosis who underwent frontalis slings with fascia lata (autogenous and banked) and temporalis fascia. Mean postoperative time was 10.7 years ± 3.8 SD. Seventeen age-matched normal subjects comprised the control group. Lid movements as well as the magnitude of brow motion were quantified in all participants with an opto-electronic device that automatically corrected any head movement.
Most patients (77.4%) displayed lagophthalmos on eyelid closure. The lid saccades of the patients were severely restricted and did not increase beyond 30 degrees of downgaze. The maximum velocity of lid saccades was also abnormally low. Although the pre- and postoperative lid positions did not differ between eyes operated with the three types of slings, interocular analysis of patients who had bilateral surgery showed that the restrictive effect on the saccadic movements was more asymmetrical with banked fascia than with autogenous tissue. Overall, there was a significant negative correlation between the surgical effect with frontalis contraction and maximum saccadic amplitude. While in controls brow motion accounted for about 3.3-9.3% of the lid saccades, it was responsible for more than 43.5-57.4% lid movements in the patients.
Fascial slings have a permanent restrictive effect on the elastic properties of the lids. Postoperative lagophthalmos is a natural consequence of any type of fascial sling. Downward saccadic amplitude is negatively correlated with the surgical effect with frontalis contraction.
测量使用筋膜组织的额肌悬吊术对下睑扫视运动的长期影响。方法：对19例先天性上睑下垂患者进行了阔筋膜（自体和保存）及颞肌筋膜额肌悬吊术，测量其向下注视10°、20°、30°、40°和50°时的下睑扫视运动。术后平均时间为10.7年±3.8标准差。17名年龄匹配的正常受试者组成对照组。使用光电设备对所有参与者的眼睑运动以及眉毛运动幅度进行量化，该设备可自动校正任何头部运动。
大多数患者（77.4%）在闭眼时出现兔眼症。患者的眼睑扫视严重受限，向下注视超过30°时不再增加。眼睑扫视的最大速度也异常低。虽然三种类型悬吊术手术的眼睛术前和术后眼睑位置无差异，但对接受双侧手术患者的双眼分析表明，保存筋膜对扫视运动的限制作用比自体组织更不对称。总体而言，额肌收缩的手术效果与最大扫视幅度之间存在显著负相关。在对照组中，眉毛运动占眼睑扫视的约3.3%-9.3%，而在患者中，眉毛运动占眼睑运动的43.5%-57.4%以上。
筋膜悬吊术对眼睑的弹性特性有永久性限制作用。术后兔眼症是任何类型筋膜悬吊术的自然结果。向下扫视幅度与额肌收缩的手术效果呈负相关。
