Goel Ruchi, Singh Sonam, Shah Shalin, Khanam Samreen, Golhait Priyanka, Gaonker Tanvi
Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.
Taiwan J Ophthalmol. 2024 Jan 5;15(1):120-125. doi: 10.4103/tjo.TJO-D-23-00081. eCollection 2025 Jan-Mar.
The purpose of this study was to compare the outcomes of "closed posterior levator advancement" (CPLA) in acquired aponeurotic and simple congenital ptosis with good levator function (LF).
A prospective interventional study was conducted on 20 adult patients, 10 simple congenital ptosis, and 10 acquired aponeurotic ptosis with LF ≥8 mm. Complicated, posttraumatic, neurogenic ptosis and previous lid surgery were excluded. A detailed history and assessment of visual acuity, upper eyelid margin reflex distance (MRD1), margin-crease distance, LF, Bell's phenomenon, ocular surface disease index (OSDI), and phenylephrine test were undertaken. CPLA was performed in the 20 eyes and were followed up for 3 months.
The ages of the study participants ranged from 18 to 64 years, and the male: female ratio was 11:9. There were nine aponeurotic and one congenital severe ptosis, the remaining 10 being mild-moderate ptosis. The etiologies in the aponeurotic group were involutional (2), contact lens wear (1), allergic conjunctivitis (3), and idiopathic in four eyes. The success rates were 90% in both groups. The amount of ptosis correction showed a positive relation with LF ( = 0.6, = 0.004) and phenylephrine test ( = 0.7, < 0.001). The complications in the aponeurotic group were lagophthalmos (2/10), subjective dry eye (2/10), subconjunctival hemorrhage (1/10), symblepharon (1/10), temporal flare (1/10), and overcorrection (1/10). The congenital group showed only undercorrection (1/10).
CPLA is an effective procedure for the treatment of mild-moderate simple congenital and all grades of aponeurotic ptosis with good LF. Response to phenylephrine test serves as a useful guide to the amount of ptosis correction.
本研究旨在比较“闭合式提上睑肌后徙术”（CPLA）治疗获得性腱膜性上睑下垂和单纯先天性上睑下垂且提上睑肌功能（LF）良好的疗效。
对20例成年患者进行前瞻性干预研究，其中10例为单纯先天性上睑下垂，10例为获得性腱膜性上睑下垂，LF≥8mm。排除复杂性、创伤后、神经源性上睑下垂及既往眼睑手术史患者。详细记录病史，并评估视力、上睑缘反射距离（MRD1）、睑缘-皱襞距离、LF、贝尔现象、眼表疾病指数（OSDI）及去氧肾上腺素试验。对20只眼行CPLA手术，并随访3个月。
研究参与者年龄在18至64岁之间，男女比例为11:9。腱膜性上睑下垂9例，先天性重度上睑下垂1例，其余10例为轻中度上睑下垂。腱膜性上睑下垂组的病因包括退行性变（2例）、佩戴隐形眼镜（1例）、过敏性结膜炎（3例），4例病因不明。两组成功率均为90%。上睑下垂矫正量与LF（r = 0.6，P = 0.004）及去氧肾上腺素试验（r = 0.7，P < 0.001）呈正相关。腱膜性上睑下垂组的并发症包括兔眼（2/10）、主观干眼（2/10）、结膜下出血（1/10）、睑球粘连（1/10）、颞侧闪光感（1/10）及矫正过度（1/10）。先天性上睑下垂组仅出现矫正不足（1/10）。
CPLA是治疗轻中度单纯先天性上睑下垂及所有程度腱膜性上睑下垂且LF良好的有效方法。去氧肾上腺素试验结果可作为上睑下垂矫正量的有用指导。
