经结膜 Müller 肌后退联合提上睑肌切断术与金植入物治疗麻痹性睑裂闭合不全的疗效比较。
Outcome Comparison of Transconjunctival Müller's Muscle Recession With Levator Disinsertion (TMRLD) to Gold Weight Implantation in the Treatment of Paralytic Lagophthalmos.
机构信息
Oculofacial Plastic and Orbital Surgery, Carmel, Indiana, U.S.A.
Ascension St. Vincent Hospital, Indianapolis, Indiana, U.S.A.
出版信息
Ophthalmic Plast Reconstr Surg. 2024;40(3):326-330. doi: 10.1097/IOP.0000000000002582. Epub 2024 Jan 12.
PURPOSE
To compare clinical outcomes of transconjunctival Müller's muscle recession with levator disinsertion (TMRLD) to the traditional gold weight implantation in patients with paralytic lagophthalmos.
METHODS
A retrospective nonrandomized comparative review of patients who had gold weight implantation and TMRLD surgeries for paralytic lagophthalmos from January 2016 to January 2023 was performed. The main outcome comparisons were measurement changes in lagophthalmos, marginal reflex distance 1, visual acuity, and corneal examination. Complication and reoperation rates were also compared.
RESULTS
Twenty-six cases of gold weight implantation and 20 cases of TMRLD surgeries were identified. The changes in logMAR visual acuity between gold weight implantation and TMRLD groups were not statistically significant (-0.10 ± 0.48 vs. +0.05 ± 0.14, p > 0.05). The percent improvement in lagophthalmos (62.2% ± 51.8% vs. 58.4% ± 21.1%) and final marginal reflex distance 1 (2.22 ± 1.42 vs. 2.25 ± 1.41 mm) were also comparable between groups ( p > 0.05). Both groups showed similar changes in marginal reflex distance 1 (1.75 ± 1.31 vs. 2.83 ± 1.37 mm) and lagophthalmos (3.77 ± 3.92 vs. 3.36 ± 1.36 mm) ( p > 0.05). The overall complication (15.4% vs. 15.0%) and reoperation rates (15.4% vs. 15.0%) were comparable over the follow-up duration (291.6 ± 437.3 vs. 121.0 ± 177.8 days) ( p > 0.05).
CONCLUSION
TMRLD is as safe and effective as the gold weight implantation in addressing paralytic lagophthalmos in patients with facial nerve palsy.
目的
比较经结膜 Müller 肌退缩联合提上睑肌离断术（TMRLD）与传统金植入术治疗麻痹性上睑下垂的临床疗效。
方法
回顾性分析了 2016 年 1 月至 2023 年 1 月期间因麻痹性上睑下垂行金植入术和 TMRLD 手术的患者，比较两组患者的上睑下垂测量值、瞬目反射距离 1（MRD1）、视力和角膜检查结果。比较两组的并发症和再手术率。
结果
共纳入 26 例金植入术和 20 例 TMRLD 手术患者。金植入术组和 TMRLD 组的 logMAR 视力变化差异无统计学意义（-0.10±0.48 比+0.05±0.14，p＞0.05）。上睑下垂的改善百分比（62.2%±51.8%比 58.4%±21.1%）和最终的 MRD1（2.22±1.42 比 2.25±1.41 mm）也相似（p＞0.05）。两组的 MRD1（1.75±1.31 比 2.83±1.37 mm）和上睑下垂（3.77±3.92 比 3.36±1.36 mm）的变化也相似（p＞0.05）。随访期间（291.6±437.3 比 121.0±177.8 天），两组的总并发症发生率（15.4%比 15.0%）和再手术率（15.4%比 15.0%）相似（p＞0.05）。
结论
TMRLD 与金植入术治疗面神经麻痹所致的麻痹性上睑下垂同样安全有效。
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