Dawood Ahmed Said, Hassan Omar Abdelghany, El Sayed Mohamed Othman
Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom.
Department of Oculoplastic Surgery, Research Institute of Ophthalmology, Giza, Egypt.
Oman J Ophthalmol. 2021 Oct 20;14(3):173-178. doi: 10.4103/ojo.ojo_127_21. eCollection 2021 Sep-Dec.
Treating congenital blepharoptosis is often mandatory to clear the visual access and avoid amblyopia; however, when the levator function is poor, achieving a satisfactory long-term outcome is challenging. This study aimed to compare the outcomes of maximal levator resection (MLR) with those of frontalis suspension (FS) using Gore-Tex , in the treatment of congenital blepharoptosis with poor levator function.
The study included 102 eyelids of 66 patients of mean age 4.3 ± 1.6 standard deviation (SD) years, randomly divided into two groups (51 eyes each). Group A: FS using Gore-Tex , Group B: MLR. Postoperative outcomes were evaluated at 1, 6 and 12 months. Patients' ophthalmic examination including margin-reflex distance (MRD1) before and after surgery and postoperative complications were recorded.
At the end of the follow-up, the mean MRD1 increased from 0.3 ± 0.7 SD mm in Group A, 0.4 ± 0.8 SD mm in Group B preoperatively, to 2.7 ± 0.5 SD mm and 2.9 ± 0.7 SD mm, respectively ( < 0.001 in both groups). Results of Group B were significantly higher than Group A ( = 0.047). Success was achieved in 77 eyelids (75.4%), distributed as follows: 36 eyelids (70.6%) in Group A, and 41 eyelids (80.1%) in Group B. The total recurrence rate was 6.9% (seven eyes), while other complications were recorded in 23 eyes (22.5%).
MLR, compared to FS with Gore-Tex sling, can be a more efficient surgical option to correct congenital blepharoptosis with poor levator excursion. Prominent postoperative lagophthalmos warrants close ocular surface observation in early follow-up weeks.
治疗先天性上睑下垂通常对于清除视觉通路和避免弱视是必要的；然而，当上睑提肌功能较差时，实现满意的长期效果具有挑战性。本研究旨在比较使用 Gore-Tex 进行最大提肌切除术（MLR）与额肌悬吊术（FS）在治疗提肌功能差的先天性上睑下垂中的效果。
该研究纳入了 66 例平均年龄为 4.3±1.6 标准差（SD）岁患者的 102 只眼睑，随机分为两组（每组 51 只眼）。A 组：使用 Gore-Tex 进行额肌悬吊术；B 组：最大提肌切除术。在术后 1、6 和 12 个月评估术后效果。记录患者手术前后的眼科检查，包括睑缘反射距离（MRD1）以及术后并发症。
在随访结束时，A 组平均 MRD1 从术前的 0.3±0.7 SD mm 增加到 2.7±0.5 SD mm，B 组从术前的 0.4±0.8 SD mm 增加到 2.9±0.7 SD mm（两组均 P<0.001）。B 组结果显著高于 A 组（P = 0.047）。77 只眼睑（75.4%）获得成功，分布如下：A 组 36 只眼睑（70.6%），B 组 41 只眼睑（80.1%）。总复发率为 6.9%（7 只眼），同时 23 只眼（22.5%）记录有其他并发症。
与使用 Gore-Tex 吊带的额肌悬吊术相比，最大提肌切除术可能是矫正提肌活动度差的先天性上睑下垂更有效的手术选择。术后明显的兔眼症需要在随访早期密切观察眼表情况。
