Mauriello J A, Abdelsalam A
Department of Ophthalmology, UMD-New Jersey Medical School, Newark 07103-2499, USA.
Ophthalmic Plast Reconstr Surg. 1998 Jul;14(4):266-70. doi: 10.1097/00002341-199807000-00008.
The results of a "modified" levator aponeurotic advancement were reviewed to determine the appropriate indications and optimum timing for office revision after blepharoptosis repair. The levator advancement was modified as follows: 1) elimination of epinephrine from the local anesthetic so as not to stimulate the Müller muscle, 2) use of a 6-0 silk rather than a monofilament nonabsorbable suture to secure the advanced levator to avoid possible cheese-wiring and late recurrence, and 3) excision of a strip of preseptal orbicularis muscle just above the tarsal border to create surgically apposed "raw" surfaces for a firm attachment of the "advanced" levator. Office adjustments were delayed for at least 8 days after surgery and were performed as late as 14 days after surgery. Of the 122 consecutive aponeurotic advancements in 110 patients (12 bilateral cases), five (4.1%) patients were candidates for revision in that the operated eyelid was greater than 1 mm from desired height. All such eyelids were undercorrected by 2.0 mm to 2.5 mm. Four of the five underwent revision at 8, 11, and 14 days (two patients) after surgery. The fifth patient did not undergo revision. Four patients with overcorrections from 2.0 mm to 2.5 mm resolved with eyelid massage. It is concluded that the number of office revisions may be reduced if delayed for at least 8 days after surgery. This delay allows for resolution of postoperative edema and objective prediction of final eyelid position. The advantages of this "modified" levator advancement procedure are discussed.
回顾“改良”提上睑肌腱膜前移术的结果，以确定上睑下垂修复术后门诊修复的合适适应证和最佳时机。提上睑肌腱膜前移术改良如下：1）局部麻醉剂中不使用肾上腺素，以免刺激米勒肌；2）使用6-0丝线而非单丝不可吸收缝线固定前移的提上睑肌，以避免可能的“奶酪布线”和后期复发；3）在睑板上缘上方切除一条眶隔前眼轮匝肌，以形成手术对合的“粗糙”表面，使“前移”的提上睑肌牢固附着。术后至少延迟8天进行门诊调整，最晚在术后14天进行。在110例患者（12例双侧病例）连续进行的122次腱膜前移术中，有5例（4.1%）患者因手术侧眼睑比预期高度高1mm以上而需要修复。所有这些眼睑均矫正不足2.0mm至2.5mm。5例患者中有4例在术后8天、11天和14天（2例患者）进行了修复。第5例患者未进行修复。4例矫正过度2.0mm至2.5mm的患者通过眼睑按摩得到改善。结论是，如果术后至少延迟8天进行门诊修复，修复次数可能会减少。这种延迟有助于术后水肿消退，并能客观预测最终眼睑位置。文中讨论了这种“改良”提上睑肌腱膜前移术的优点。
