Zhang L, Li B, Li L, Li Y, Zhang Y, Li D M
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab., Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2018 Sep 11;54(9):671-677. doi: 10.3760/cma.j.issn.0412-4081.2018.09.007.
To observe pathological features of levator aponeurosis in patients with involutional ptosis. A prospective study. Twenty-nine consecutive patients with involutional blepharoptosis who underwent levator aponeurosis advancement surgery for blepharoptosis correction were enrolled at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from 2007 to 2013. Twenty-nine specimens of the levator aponeurosis were obtained during surgery. Hematoxylin-eosin staining, Van Gieson staining, Masson staining, immunohistochemistry and transmission electron microscope observations were performed to observe the features of levator aponeurosis. Twelve normal specimens of fresh levator aponeurosis were obtained from Beijign Tongren Eyebank as control group. Mann-Whitney's -test and multiple linear regression were used for statistical analysis. Among the enrolled cases, there were 19 males and 10 females;14 cases were diagnosed with moderate ptosis and 15 cases with severe ptosis;9 cases involved with both eyes, 9 cases with right eyes, and 11 cases with left eyes. The mean age was 59 years. Among the 12 normal cases, there were 5 males and 7 females. The mean age was 56 years. Histopathological observation showed fascicle disruption(+++, ++, + 24, 2, 3 . 0, -5.666, 0.001), scarcity of cross-striations(+++, ++, + 23, 2, 4 . 0, -5.582,0.001), collagen fibers hyperplasia(+++, ++, + 15, 10, 4 . 0, -5.223,0.001), fatty infiltration(+++, ++, + 24, 5, 0 . 0, -5.671,0.001), and a decrease of myoglobin expression(+++,++,+,- 9, 1, 1, 15 . 8, 1, 0, 0, -3.004, 0.005) in levator aponeurosis. Transmission electron microscope recorded presence of collagen fiber hyperplasia and cellular degeneration including mitochondria swelling and hyperplasia, vacuoles, lipid droplets, nucleus pycnosis, chromosome condensation, disintegrated organelles, myeloid body and autophagy. Multivariate linear regression showed a correlation between fat infiltration and age(β=0.425, 0.043) while suspicious related clinical features as independent variables and observed histopathological features as dependent variables. The levator aponeurosis appears to be involved with muscle fiber degeneration, collagen fiber hyperplasia and cellular degeneration in patients with involutional blepharoptosis. .
观察老年性上睑下垂患者提上睑肌腱膜的病理特征。一项前瞻性研究。2007年至2013年期间，首都医科大学附属北京同仁医院北京同仁眼科中心连续纳入29例因老年性上睑下垂接受提上睑肌腱膜缩短术矫正上睑下垂的患者。术中获取29份提上睑肌腱膜标本。采用苏木精-伊红染色、Van Gieson染色、Masson染色、免疫组织化学及透射电镜观察提上睑肌腱膜的特征。从北京同仁眼库获取12份新鲜提上睑肌腱膜正常标本作为对照组。采用Mann-Whitney检验和多元线性回归进行统计分析。纳入病例中，男性19例，女性10例；中度上睑下垂14例，重度上睑下垂15例；双眼受累9例，右眼9例，左眼11例。平均年龄59岁。12例正常病例中，男性5例，女性7例。平均年龄56岁。组织病理学观察显示提上睑肌腱膜存在肌束断裂（+++：24例，++：2例，+：3例；P=0.001）、横纹缺失（+++：23例，++：2例，+：4例；P=0.001）、胶原纤维增生（+++：15例，++：10例，+：4例；P=0.001）、脂肪浸润（+++：24例，++：5例，+：0例；P=0.001）以及肌红蛋白表达减少（+++：9例，++：1例，+：1例，-：1例；P=0.005）。透射电镜观察显示存在胶原纤维增生和细胞变性，包括线粒体肿胀和增生、空泡形成、脂滴、核固缩、染色体凝聚、细胞器崩解、髓样体及自噬。多因素线性回归显示脂肪浸润与年龄相关（β=0.425，P=0.043），以可疑相关临床特征为自变量，观察到的组织病理学特征为因变量。老年性上睑下垂患者的提上睑肌腱膜似乎存在肌纤维变性、胶原纤维增生和细胞变性。
