Graves 眼病的上睑退缩：我们对 153 例全层前睑切开术联合 Muller 肌切除术的手术经验。

Upper Eyelid Retraction in Graves' Ophthalmopathy: Our Surgical Experience on 153 Cases of Full-Thickness Anterior Blepharotomy with Mullerectomy.

机构信息

Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy.

Referral Centre for Graves' Ophthalmopathy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.

出版信息

Aesthetic Plast Surg. 2022 Aug;46(4):1713-1721. doi: 10.1007/s00266-022-02770-5. Epub 2022 Feb 7.

DOI:10.1007/s00266-022-02770-5

PMID:35129648

Abstract

BACKGROUND

We present our experience on 153 cases of full-thickness anterior blepharotomy with mullerectomy (FTABM) in the treatment of upper eyelid retraction (UER) related to Graves' ophthalmopathy (GO).

METHODS

We included all the patients who underwent a graded FTABM between 1 January 2015 and 30 June 2020 for UER GO-related. The analysis included: pre-/post-operative conjunctival symptoms, epiphora, GO-Quality of Life Questionnaire (QoL), lagophthalmos, marginal reflex distance (MRD-1) index, eyelid symmetry within 1mm. The statistical analysis was designed to detect postoperative improvement in objective and subjective clinical features. Outcomes were analysed through Chi-squared test for dichotomous variables and through Wilcoxon-Mann-Whitney test for continuous variables.

RESULTS

Of the 111 patients, 42 underwent a bilateral procedure, while 69 a monolateral. Conjunctival symptoms were reported in 32% of cases before surgery and in 12.4% after FTABM (p < 0.001). Epiphora was complained by 29.6% of patients preoperatively and in 12.4% postoperatively (p < 0.001). Preoperative lagophthalmos was found in 12.4% (mean value of 0.34 ± 0.76 mm) of eyelids, and in 2.6% (mean value 0.05 ± 0.19 mm) eyelids (p = not significant) postoperatively. Pre-operative GO-QoL was 24.9 ± 4.4 mm; while post-operative GO-QoL was 35.3 ± 5.5 mm (p < 0.001). The MRD-1 varied from 10.12 ± 2.1 mm preoperatively, to 4.3 ± 0.6 mm (p < 0.001) after surgery. Asymmetric palpebral fissure was noted in 94 (84.7%) patients before surgery and in 7 (6.3%) after the procedure (p < 0.001).

CONCLUSION

FTABM is an effective procedure to treat UER GO-related. The technique manages to prevent complications of UER and determine good aesthetics.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Level IV, therapeutic study.

摘要

背景

我们介绍了我们在 153 例 Graves 眼病（GO）相关上睑退缩（UER）行全层睑板前切除术联合 Muller 肌切除术（FTABM）的经验。

方法

我们纳入了 2015 年 1 月 1 日至 2020 年 6 月 30 日期间接受分级 FTABM 治疗 GO 相关 UER 的所有患者。分析包括：术前和术后结膜症状、溢泪、GO 生活质量问卷（GO-QoL）、睑裂闭合不全、Marginal Reflex Distance（MRD-1）指数、眼睑 1mm 内的对称性。统计学分析旨在检测术后客观和主观临床特征的改善。通过卡方检验分析二分类变量，通过 Wilcoxon-Mann-Whitney 检验分析连续变量。

结果

111 例患者中，42 例行双侧手术，69 例行单侧手术。术前有 32%的患者有结膜症状，术后有 12.4%（p<0.001）。术前有 29.6%的患者抱怨溢泪，术后有 12.4%（p<0.001）。术前睑裂闭合不全发生率为 12.4%（平均 0.34±0.76mm），术后为 2.6%（平均 0.05±0.19mm）（p=无显著性）。术前 GO-QoL 为 24.9±4.4mm，术后为 35.3±5.5mm（p<0.001）。MRD-1 术前为 10.12±2.1mm，术后为 4.3±0.6mm（p<0.001）。术前不对称性睑裂 94 例（84.7%），术后 7 例（6.3%）（p<0.001）。