Hasbi Amirul, Shatriah Ismail, Tai Evelyn Li Min, Rahim Haslinda A, Zamli Akmal Haliza
Department of Ophthalmology and Visual Science, Hospital Pakar Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia.
Korean J Ophthalmol. 2024 Dec;38(6):450-460. doi: 10.3341/kjo.2024.0102. Epub 2024 Oct 22.
Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery.
A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children's Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery.
This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001).
Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.
在全球范围内，关于先天性上睑下垂患儿的心理社会功能和健康相关生活质量（HRQoL）的信息有限，矫正手术对这些参数的影响也不清楚。本研究旨在评估马来西亚原发性单纯性单侧先天性上睑下垂患儿在进行上睑下垂手术后的社交焦虑和HRQoL。
对2022年至2024年期间在三家三级医院就诊的原发性单纯性单侧先天性上睑下垂患儿及其父母/监护人进行了一项前瞻性队列研究。患者及其父母/监护人在招募时和上睑下垂手术后3个月回答了斯宾斯儿童焦虑量表-社交焦虑量表和儿童生活质量量表4.0通用核心量表。
本研究纳入了45名儿童，其中26名（57.8%）为女性。入组时，18名（40.0%）患有重度上睑下垂，15名（33.3%）患有弱视。所有手术均成功，平均边缘至反射距离（MRD）1和双眼MRD1差值分别为4.07±0.62和（0.29±0.46）mm。手术后观察到儿童及其父母的社交焦虑和HRQoL均有显著改善（p<0.001）。术后双眼MRD1差值的减小是影响上睑下垂患儿术后社交焦虑的唯一显著因素（p<0.001）。与弱视的存在（p<0.001）一起，发现双眼MRD1差值对HRQoL的改善有显著影响（p=0.021）。发现父母/监护人的年龄、性别和教育水平对上睑下垂手术后社交焦虑的变化有显著影响（p<0.05），而与父母HRQoL改善最相关的因素是上睑下垂眼的MRD1改善（p<0.001）。
上睑下垂手术显著改善了先天性上睑下垂患儿及其父母/监护人的社交焦虑和HRQoL。在确定先天性上睑下垂患儿的手术指征时，应考虑心理社会功能。
