Department of Ophthalmology, Jikei University School of Medicine, Tokyo, 105-8471, Japan.
Department of Ophthalmology, Daisan Hospital, The Jikei University School of Medicine, Komae, Tokyo, Japan.
Graefes Arch Clin Exp Ophthalmol. 2020 Jun;258(6):1287-1292. doi: 10.1007/s00417-020-04627-6. Epub 2020 Feb 26.
To examine the influence of epinephrine contained in local anesthetic on upper eyelid height in transconjunctival aponeurotic repair for aponeurotic blepharoptosis.
This retrospective study included 164 eyelids from 94 patients with aponeurotic blepharoptosis. Patients were divided according to the use of local anesthetic with (group A, n = 108) or without 1:100000 epinephrine (group B, n = 56). Margin reflex distance-1 (MRD-1) was measured before and after local anesthesia, and before, during, and 3 months after surgery. Change in MRD-1 (∆MRD-1) was calculated by subtracting the postanesthetic MRD-1 value from the preanesthetic value, and we defined ∆MRD-1 by subtracting the postoperative 3-month MRD-1 value from the intraoperative value.
∆MRD-1 was positive in group A (0.57 ± 0.63 mm) and negative in group B (- 0.50 ± 0.45 mm; p < 0.001). Postoperative MRD-1 decreased significantly from intraoperative MRD-1 in group A (P < 0.001), although there was no significant difference between intraoperative and postoperative MRD-1 in group B (p = 0.255). The magnitude of ∆MRD-1 in group A (- 0.86 ± 0.63) was larger than that in group B (- 0.23 ± 0.26; p < 0.001).
Epinephrine stimulates Müller's muscle during surgery, which leads to postoperative upper eyelid droop after the disappearance of the epinephrine effect. Using local anesthetics without epinephrine may allow more accurate estimation of postoperative eyelid height in transconjunctival aponeurotic repair.
探讨局部麻醉剂中肾上腺素对上睑高度的影响在经结膜腱膜修复术治疗腱膜性上睑下垂中的作用。
本回顾性研究纳入了 94 例腱膜性上睑下垂患者的 164 只眼睑。根据是否使用含 1:100000 肾上腺素的局部麻醉剂将患者分为两组（A 组，n=108；B 组，n=56）。在局部麻醉前后测量了边缘反射距离-1（MRD-1），并在手术前、手术期间和术后 3 个月测量了 MRD-1。通过从麻醉前值中减去麻醉后 MRD-1 值计算出 MRD-1 的变化值（∆MRD-1），我们还通过从术中值中减去术后 3 个月的 MRD-1 值定义了 ∆MRD-1。
A 组的 ∆MRD-1 为正值（0.57±0.63mm），B 组的 ∆MRD-1 为负值（-0.50±0.45mm；p<0.001）。A 组术后 MRD-1 明显低于术中 MRD-1（P<0.001），而 B 组术中与术后 MRD-1 之间无显著差异（p=0.255）。A 组的 ∆MRD-1（-0.86±0.63）明显大于 B 组（-0.23±0.26；p<0.001）。
肾上腺素在手术期间刺激 Müller 肌，导致肾上腺素作用消失后出现术后上睑下垂。使用不含肾上腺素的局部麻醉剂可能更有助于准确估计经结膜腱膜修复术后的眼睑高度。
