From the First Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Plast Reconstr Surg. 2024 Aug 1;154(2):417-424. doi: 10.1097/PRS.0000000000010997. Epub 2023 Aug 15.
This retrospective case series presents the clinical results of a modified 1-stage comprehensive surgical method for blepharophimosis-ptosis-epicanthus inversus syndrome (BPES).
A total of 25 patients with BPES underwent a modified reverse Z-plastic surgery method to bisect the epicanthus into 2 unequal V-shaped flaps and suture them alternately. The medial canthus ligament was partially incised, shortened, and sutured; the outer canthus was opened with a V-Y flap. The gray line of the outer canthus was cut to extend the eyelid margin length. Ptosis was corrected using the orbicularis oculi-frontalis composite flap technique. We studied the inner intercanthal distance (IICD), interpupillary distance (IPD), horizontal palpebral fissure length (HPFL), marginal reflex distance 1 (MRD-1), IICD/IPD ratio, IICD/HPFL ratio, Vancouver Scar Scale, and overall postoperative satisfaction.
The 25 patients included 12 girls and 13 boys (mean age, 8.3 ± 6.8 years), 19 of whom had a family history of BPES. The mean IPD value was 50.15 ± 7.43 mm. IICD decreased from 39.38 ± 2.39 mm preoperatively to 31.64 ± 2.37 mm postoperatively, IICD/IPD from 0.8 ± 0.1 preoperatively to 0.6 ± 0.1 postoperatively ( P < 0.05), and IICD/HPFL from 1.98 ± 0.33 preoperatively to 1.22 ± 0.10 postoperatively ( P < 0.01). HPFL increased from 20.08 ± 3.53 mm preoperatively to 26.04 ± 1.36 mm postoperatively ( P < 0.01), and MRD-1 from -1.12 ± 0.71 mm preoperatively to 3.24 ± 0.47 mm postoperatively ( P < 0.01). The postoperative Vancouver Scar Scale score was 3.68 ± 1.07. Patient satisfaction was rated as 8.8 ± 1.08, with a relatively high overall satisfaction rate.
The corrective effect on BPES was noticeable, improving the IICD/HPFL and IICD/IPD ratios. Postoperative scars were not evident, and patient satisfaction was high.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本回顾性病例系列报告了改良的 1 期综合手术方法治疗睑裂狭小-上睑下垂-内眦赘皮倒向综合征（BPES）的临床结果。
25 例 BPES 患者采用改良的反向 Z 成形术将内眦切开成 2 个不相等的 V 形皮瓣并交替缝合。部分切开、缩短和缝合内眦韧带；外眦采用 V-Y 皮瓣张开。外眦灰线切开以延长睑缘长度。采用眼轮匝肌-额肌复合瓣技术矫正上睑下垂。我们研究了内眦间距（IICD）、瞳孔间距（IPD）、水平睑裂长度（HPFL）、角膜缘反射距离 1（MRD-1）、IICD/IPD 比值、IICD/HPFL 比值、温哥华瘢痕量表和整体术后满意度。
25 例患者包括 12 名女孩和 13 名男孩（平均年龄 8.3±6.8 岁），其中 19 例有 BPES 家族史。平均 IPD 值为 50.15±7.43mm。IICD 从术前的 39.38±2.39mm 降至术后的 31.64±2.37mm，IICD/IPD 从术前的 0.8±0.1 降至术后的 0.6±0.1（P<0.05），IICD/HPFL 从术前的 1.98±0.33 降至术后的 1.22±0.10（P<0.01）。HPFL 从术前的 20.08±3.53mm 增加到术后的 26.04±1.36mm（P<0.01），MRD-1 从术前的-1.12±0.71mm 增加到术后的 3.24±0.47mm（P<0.01）。术后温哥华瘢痕量表评分为 3.68±1.07。患者满意度评分为 8.8±1.08，总体满意度较高。
BPES 的矫正效果明显，改善了 IICD/HPFL 和 IICD/IPD 比值。术后瘢痕不明显，患者满意度高。
临床问题/证据水平：治疗，IV。
