John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences.
Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Ophthalmic Plast Reconstr Surg. 2021;37(3S):S80-S84. doi: 10.1097/IOP.0000000000001823.
To describe the incidence of anophthalmic ptosis, identify clinical factors associated with its development, and evaluate the effects of enucleation on eyelid mechanics.
In this observational cohort study, measurements and photographs were reviewed in 139 patients who underwent enucleation between 2007 and 2016. Patient demographics, pre- and postoperative eyelid measurements, and exophthalmometry were used to assess the incidence of ptosis and effects of surgery on eyelid function.
Preoperative ptosis was common and more often present in patients with enophthalmos (p = 0.0305) or reactive blepharospasm (p < 0.0001). The incidence of new-onset ptosis and improvement of preexisting ptosis following enucleation were similar (40%). Surgical repair was performed in 7% of patients with ptosis. Contralateral levator function declined with age and was positively correlated with exophthalmometry (p < 0.0001). Anophthalmic levator function was greater with increased anterior projection of the implant (p < 0.0001) and prosthesis (p < 0.0001). Patients with larger implants had improved levator function, with (p = 0.0065) and without (p = 0.0007) the prosthesis. Superior sulcus deepening was associated with decreased levator activity, but not margin-reflex distance.
Preoperative ptosis was common, and often related to reactive blepharospasm or enophthalmos. Levator function declined with age, and correlated to greater anterior projection of the implant and prosthesis following enucleation. The surgeon can counsel patients regarding the similar likelihood (40%) of preoperative ptosis improving and new ptosis developing after enucleation. The primary factor the surgeon can modify to improve postoperative eyelid function is to maximize implant size, which is associated with greater levator activity.
描述无眼球性上睑下垂的发生率，确定与该病发生相关的临床因素，并评估眼窝内容物剜除术对眼睑力学的影响。
在这项观察性队列研究中，回顾了 2007 年至 2016 年间进行眼窝内容物剜除术的 139 例患者的测量值和照片。患者的人口统计学数据、术前和术后的眼睑测量值以及眼球突出度用于评估上睑下垂的发生率以及手术对眼睑功能的影响。
术前上睑下垂很常见，且在眼球内陷（p = 0.0305）或反应性眼轮匝肌痉挛（p < 0.0001）的患者中更为常见。眼窝内容物剜除术后新发上睑下垂和改善原有上睑下垂的发生率相似（40%）。有 7%的上睑下垂患者需要进行手术修复。随着年龄的增长，对侧提上睑肌功能下降，与眼球突出度呈正相关（p < 0.0001）。无眼球性提上睑肌功能与植入物（p < 0.0001）和义眼（p < 0.0001）的前突增加呈正相关。植入物较大的患者提上睑肌功能改善，有（p = 0.0065）和无（p = 0.0007）义眼的患者均如此。上睑皱襞加深与提上睑肌活动减少相关，但与睑缘退缩距离无关。
术前上睑下垂很常见，且常与反应性眼轮匝肌痉挛或眼球内陷有关。提上睑肌功能随年龄下降，与眼窝内容物剜除术后植入物和义眼的前突增加呈正相关。外科医生可以告知患者，术前上睑下垂改善和眼窝内容物剜除术后新发上睑下垂的可能性大致相同（40%）。外科医生可以改变的主要因素是使植入物最大化，以改善术后眼睑功能，这与提上睑肌活动增加有关。
