Department of Ophthalmology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Department of Ophthalmology, Van Training and Research Hospital, Van, Turkey.
Arq Bras Oftalmol. 2024 Mar 22;87(3):e20230028. doi: 10.5935/0004-2749.2023-0028. eCollection 2024.
Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Miiller's muscle conjunctival resection surgery in unilateral ptosis.
We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Miiller's muscle conjunctival resection. Eyelid contour analysis was conducted on preoperative and 6-month postoperative digital images. This was performed with the multiple margin reflex distances technique, measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. The marginal peak point changes were analyzed digitally using the coordinates of the peak point according to the pupil center. Each position's mean distance was compared preoperatively, postoperatively, and with the fellow eyelid.
Sixteen patients underwent external levator advancement and 16 patients had Miiller's muscle conjunctival resection. The mean margin reflex distance was improved by both techniques (1.46 vs. 2.43 mm and 1.12 vs. 2.25 mm, p=0.008 and p=0.0001 respectively) and approached that of the fellow eyelid (2.43 vs. 2.88 and 2.25 vs. 2.58 mm, p=0.23 and p=0.19, respectively). However, statistically significant lid margin elevation was limited to between the N6 and T6 points in the external levator advancement group. Whereas, significant elevation was achieved along the whole lid margin in the Miiller's muscle conjunctival resection group. The marginal peak point was shifted slightly laterally in the external levator advancement group (p=0.11).
Both techniques provide effective lid elevation, however, the external levator advancement's effect lessens toward the canthi while Müller's muscle conjunctival resection provides more uniform elevation across the lid margin. The margin reflex distance alone is not sufficient to reflect contour changes.
评估上睑缘轮廓和边缘峰点变化，以比较单侧上睑下垂的外直肌前徙术和 Muller 肌结膜切除术的效果。
我们回顾了行外直肌前徙术或 Muller 肌结膜切除术的单侧上睑下垂患者的病历。对术前和术后 6 个月的数字图像进行上睑缘轮廓分析。使用多重边缘反射距离技术进行分析，测量从瞳孔中心相交的直线到睑缘在 10 个位置的垂直距离，每个位置间隔 2 毫米。使用根据瞳孔中心的峰点坐标进行数字分析边缘峰点变化。比较了术前、术后和对侧眼各位置的平均距离。
16 例患者行外直肌前徙术，16 例患者行 Muller 肌结膜切除术。两种手术技术均改善了边缘反射距离（1.46 毫米 vs. 2.43 毫米和 1.12 毫米 vs. 2.25 毫米，p=0.008 和 p=0.0001），并接近对侧眼（2.43 毫米 vs. 2.88 毫米和 2.25 毫米 vs. 2.58 毫米，p=0.23 和 p=0.19）。然而，在外直肌前徙术组中，只有在 N6 到 T6 点之间，才能观察到统计学上显著的上睑缘抬高。而在 Muller 肌结膜切除术组中，整个上睑缘都有明显的抬高。在外直肌前徙术组中，边缘峰点略微向外侧移位（p=0.11）。
两种手术技术都能有效抬高上睑，但外直肌前徙术的效果在靠近眦部时减弱，而 Muller 肌结膜切除术能更均匀地抬高上睑缘。仅边缘反射距离不能充分反映轮廓变化。
