两种先天性上睑下垂矫正术后眼表改变和恢复的差异研究

Study of the Difference of Ocular Surfac e Changeand Restoration after Two Correct ion Surgeriesof Congenital Ptosis

目的:探讨上睑提肌缩短术和额肌肌瓣悬吊术后眼表改变和恢复的差异。方法:对2007年1月至2007年4月在中山眼科中心住院的42例(62只眼)先天性上睑下垂患者,按手术方式和术后是否加用局部用药进行随机分组,观测各组术后2d、5d、7d和2周患者泪液的分泌、泪膜破裂时间、结膜充血、角膜荧光染色、睑板腺功能、瞬目次数、上睑睫毛角度和眼睑闭合情况,并分析其观察结果的差异是否有统计学意义。结果:3名患者(7·1%)因需要加用其它促角膜上皮生长的药物而退出本研究,其中1例(2.3%)因倒睫刺激角膜上皮水肿缺损需行手术调整,其余所有患者眼表检测项目的结果均显示不同程度地受到了手术影响,但是随着术后炎症的逐渐消退,这些受影响的眼表异常均会逐渐恢复正常。泪膜破裂时间、瞬目次数、眼睑闭合情况的影响在两种术式之间的差异有统计学意义,而在术后是否局部用药之间没有统计学差异;角膜荧光素染色在是否加用局部用药组之间有统计学差异,而不同术式之间没有统计学差异;泪液分泌量、结膜充血、睑板腺功能、睫毛角度则在所有组别之间均没有统计学差异。结论:两种上睑下垂的矫正术均会引起患者眼表的改变,额肌肌瓣悬吊术对泪膜破裂时间、瞬目次数、眼睑闭合情况影响的程度较大,而局部用药只能改善角膜荧光素染色异常、对其它眼表因素影响不大。上睑睫毛角度异常是引起角膜损害最危险的因素。眼科学报2007;23:219-226.

Objective ： To investigate the difference of ocular surface change and restoration after extemal levator advancement and frontalis suspension. Methods ： Forty-two patients （62 eyes） Ophthalmic Center from Jarruary to April with congenital ptosis hospitalized in Zhongshan in 2007 were randomly divided into four groups according to different surgery types and with tion. Schirmer test, tear film break-up time, or without post surgery ophthalmic medica-conjunctiva congestion, cornea fluorescent pigmentation, tarsal gland function, winking frequency, angle of eyelash and eyelid closure were all observed and statistically analyzed in all groups 2 days, 5 days, 7 days and 2 weeks after surgery. Results： Except 3 patients needed advanced ophthalmic medicine, one of whom was with corneal ulceration and needed another surgery, all the others were observed with ocular surface items altered in varied degrees and gradually returned to normality as the inflammation caused by surgery recovered. Break-up time, winking frequency and eyelid closure were statistically different between the two types of surgery but not between groups with and without post surgery ophthalmic medication. Cornea fluorescent pigmentation was statistically different between groups with and without post surgery ophthalmic medication but not between the two types of surgery. The other items did not have staffstical difference in all groups. Conclusion ： The two types of surgery for ptosis correction could alter the ocular surface, but frontalis suspension affect tear film break-up time, winking frequency and eyelid closure much more than levator advancement. Ophthalmic medication after the surgery could only ameliorate cornea fluorescent pigmentation but was not necessarily to restoration of normal ocular surface. Abnormality of eyelash angle was the most dangerous factor to the cornea injury.