Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.
Department of Ophthalmology, William Osler Health System, Brampton, Ontario, Canada.
Ophthalmic Plast Reconstr Surg. 2023;39(3):237-242. doi: 10.1097/IOP.0000000000002297. Epub 2022 Oct 28.
Determine the prevalence and predictors of Hering's response following Muller's muscle-conjunctival resection (MMCR).
Seventy-five consecutive patients undergoing unilateral MMCR were recruited in this prospective, multicenter, cohort study. Margin-reflex distance-1 (MRD1) of both eyelids was recorded preoperatively and postoperatively. One hundred forty-three variables were investigated as potential predictors of a late postoperative (≥3 months) Hering's response using regression analyses. Main outcome measures were Hering's response (≥0.5 mm descent of the unoperated eyelid from baseline), and a clinically relevant Hering's response (descent of the unoperated from baseline to a MRD1 ≤ 2.0 mm, or descent from baseline such that the MRD1 of the unoperated eyelid became >1 mm lower than the operated eyelid).
Twenty-four (32.0%) patients had a late postoperative Hering's response, but only 6 (8.0%) responses were clinically relevant. A Hering's response at the immediate (OR 16.24, p = 0.02) and 1-week postoperative (OR 8.94, p = 0.04) timepoints predicted a late postoperative response. However, the presence (OR 7.84, p = 0.07) and amplitude (OR 8.13, p = 0.06) of a preoperative phenylephrine Hering's response did not predict a late postoperative response. Of the 10 patients with a clinically relevant phenylephrine Hering's response, only 1 demonstrated a clinically relevant response late postoperatively.
Unilateral MMCR induces a clinically relevant Hering's response in 8% of patients. A preoperative phenylephrine Hering's response does not predict a late postoperative Hering's response. Therefore, when unilateral phenylephrine testing unmasks contralateral blepharoptosis, only the side with blepharoptosis at baseline should be operated.
确定 Muller 肌-结膜切除术（MMCR）后 Hering 反应的发生率和预测因素。
本前瞻性、多中心队列研究共招募了 75 例单侧 MMCR 连续患者。术前和术后记录双眼睑缘反射距离 1（MRD1）。使用回归分析调查了 143 个变量，作为术后晚期（≥3 个月）Hering 反应的潜在预测因子。主要观察指标是 Hering 反应（未手术侧从上期基线下降≥0.5mm）和临床相关的 Hering 反应（未手术侧从上期基线下降至 MRD1≤2.0mm，或下降幅度使未手术侧睑缘反射距离 1 比手术侧低 1mm 以上）。
24 例（32.0%）患者术后出现晚期 Hering 反应，但只有 6 例（8.0%）反应具有临床意义。即时（OR 16.24，p=0.02）和术后 1 周（OR 8.94，p=0.04）的 Hering 反应可预测晚期术后反应。然而，术前苯肾上腺素 Hering 反应的存在（OR 7.84，p=0.07）和幅度（OR 8.13，p=0.06）均不能预测晚期术后反应。在 10 例具有临床相关苯肾上腺素 Hering 反应的患者中，仅有 1 例术后晚期出现临床相关反应。
单侧 MMCR 可使 8%的患者出现临床相关的 Hering 反应。术前苯肾上腺素 Hering 反应不能预测术后晚期的 Hering 反应。因此，当单侧苯肾上腺素试验揭示对侧上睑下垂时，仅应在基线时有上睑下垂的一侧进行手术。
