Division of Ophthalmic Plastic and Reconstructive Surgery, Sadik Eratik Eye Clinic, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Division of Cornea, Department of Ophthalmology, Okmeydani Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Korean J Ophthalmol. 2021 Feb;35(1):10-17. doi: 10.3341/kjo.2020.0119. Epub 2020 Dec 11.
To examine the efficacy of ptosis correction with a Müller muscle-conjunctival resection with or without tarsectomy (MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients.
Seven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperative visual acuity, marginal reflex distance 1 (MRD-1), presence of Hering's dependency by the phenylephrine test, symmetry outcomes, and complications after MMCR±T.
The average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up time of 10.4 months after MMCR±T. Hering's dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ± 0.55 mm, and the mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5-1 mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obvious corneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well tolerated by all patients.
Most patients achieved good surgical outcomes with the application of the BCL to protect the graft and with the use of the phenylephrine test and Hering's dependency to predict the final eyelid position and symmetry. MMCR±T combined with BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.
研究 Müler 肌-结膜切除术（联合或不联合外眦切开术）联合绷带接触镜（BCL）治疗角膜移植术后上睑下垂的疗效。
回顾性分析 7 例行 Müler 肌-结膜切除术（联合或不联合外眦切开术）治疗上睑下垂的角膜移植患者的临床资料。手术结束时在移植部位应用 BCL。收集的资料包括术前和术后视力、角膜缘反射距离 1（MRD-1）、苯肾上腺素试验 Hering 依赖性、对称性结果以及 Müler 肌-结膜切除术（联合或不联合外眦切开术）后的并发症。
穿透性角膜移植术后至 Müler 肌-结膜切除术（联合或不联合外眦切开术）的平均时间为 14 个月，Müller 肌-结膜切除术（联合或不联合外眦切开术）后的平均随访时间为 10.4 个月。Müller 肌-结膜切除术（联合或不联合外眦切开术）前，有 4 例（57.2%）患者存在 Hering 依赖性，所有患者术前苯肾上腺素试验显示 MRD-1 增加。术前平均 MRD-1 为-0.14±0.55mm，术后平均 MRD-1 为 2.35±0.89mm（p<0.0001）。Müller 肌-结膜切除术（联合或不联合外眦切开术）后，3 例患者的对称性结果为完美（<0.5mm），3 例为良好（0.5-1mm），1 例为尚可（≥1mm）。随访期间，所有患者均未出现明显的角膜上皮病变、角膜炎或角膜移植排斥/失败。所有患者均能耐受 BCL 的应用。
应用 BCL 保护移植物，结合苯肾上腺素试验和 Hering 依赖性预测最终眼睑位置和对称性，大多数患者获得了良好的手术效果。因此，Müller 肌-结膜切除术（联合或不联合外眦切开术）联合 BCL 可能是治疗角膜移植术后上睑下垂的一种替代方法。
