提上睑肌缩短治疗先天性上睑下垂术后欠矫的再手术观察

Observation of treatment of less rectified congenital ptosis by another shortening levator surgery

目的观察提上睑肌缩短治疗先天性上睑下垂术后欠矫的再次同样术式的特点和治疗效果。方法先天性上睑下垂术后欠矫病人11例13眼，首次手术方式均为提上睑肌缩短。欠矫1～4mm，提上睑肌力为5～9mm。再次以提上睑肌缩短术治疗，术中使卜睑缘较健侧高1～2mm（提上睑肌力为5～6mm时）或与健侧等高（提上睑肌力为7～9mm时），双眼病例时将双眼睑缘上提至上角巩缘（提上睑肌力为5～6mm时）或上角巩缘下1～2mm（提上睑肌力为7～9mm时）。结果随访1周至1年半，8例（72．7％）双眼睑缘完牟等高，位于上角巩缘下1～2mm；以此为标准，3例（27．3％）双眼睑缘高相差仅1～2mm（仍为欠矫）。所有病例术后均较术前有明显改善，均无严重的并发症。结论提上睑肌缩短治疗先天性睑下垂术后欠矫的再次于术，术中睑缘上提的位置与首次手术时相比可能应较低，因为术后上睑缘下降的幅度较少或不下降。

Objective Observation of effect of treatment of less rectified congenital ptosis by another shortening levator surgery and characteristics of this surgery, Methods 11 cases of less rectified congenital ptosis, 13 eyes, first surgery was all shortening levator, less rectified 1-4mm, levator functions was 5- 9mm. Another shortening levator surgery performed. During operations, lift superior lid margin higher 1 - 2mm than another eye＇s （when levator functions was 5 - 6mm）, lift superior lid margin to equal height of another eye＇s （when levator functions was 7-9mm）, to bilateral cases, lift superior lid margin of two eyes to the superior edge of conea （when levator functions was 5- 6mm）, or lower 1- 2mm than the height of superior edge of cornea. Results Followup for 1 week to 1.5 years, 8 cases （72.7 % ） completely rectified, superior lid margins were on the height of lower 1- 2mm than superior edge of cornea. According to this standard, 3 cases （27.7%） less rectified 1- 2mm. All cases were without any serious complications. Conclusions For treatment of less rectified congenital ptosis by another shortening levator surgery, maybe should lift superior lid lower than the height in first same surgery, because of lower dropping or without dropping of superior lid postoperationally,