中重度Marcus-Gunn综合征患者的手术治疗

Surgical treatment of moderate and severe Marcus-Gunn syndrome

目的分析中重度Marcus-Gunn综合征患者的临床特点,评价其手术治疗效果。方法收集武汉大学人民医院2006年1月至2010年1月收住院治疗的12例中重度Marcus-Gunn综合征患者的病历资料,对其临床特点进行分析。患者均行患眼提上睑肌离断联合同侧额肌瓣悬吊术治疗颌动瞬目现象,术后随访6个月,依据静态时双眼睑弧度及对称情况、颌动瞬目现象根治情况评价其术后治疗效果。结果所有患者术前下颌运动时上睑至少开大到角膜上缘,男性多于女性(男8例,女4例),均为单眼发病,右眼7例,左眼5例。术前8眼伴随屈光不正,5眼伴有斜视。术后2眼出现角膜点样损害,药物治疗7d后恢复。随访期末进行颌动瞬目矫治效果评价中10眼效果良好,2眼效果满意。结论中重度Marcus-Gunn综合征患者伴有的颌动瞬目现象可通过手术治疗,患侧提上睑肌离断联合同侧额肌肌瓣悬吊术可以满意地矫正Marcus-Gunn综合征患者伴有的中重度颌动瞬目现象。

Objective To analyze the clinical characteristics of Marcus-Gunn syndrome and to evaluate its surgical management.Methods Twelve patients with Marcus-Cunn syndrome were enrolled from January,2006 to January,2010 in department of Ophthalmology,Renmin Hospital of Wuhan University.The clinical characteristics were analyzed based on the records.Levator excision and frontalis suspension were performed for the correction jaw-winking synkinesis.The follow-up period was six months.Based on the curvature and symmetry of binocular eyelid and the situation after surgical treatment to jaw-winking synkinesis,the results were analyzed.Results Before operation,upper eyelid was at least opened to corneal superior margin when moving lower jaw,and found more in the male than those in the female（8 male patients and 4 female patients）.The disease involved in single eye,7 cases in the right eye and 5 cases in the left eye.Before operation,there were 8 eyes with ametropia and 5 eyes with strabismus.After operation,there were 2 eyes with corneal spotting injury,and recovered with drug treatment for 7 days.At the end of following up,good results were achieved for jaw-winking synkinesis correction,10 eyes with better results and 2 eyes with satisfactory results.Conclusions The moderate and severe jaw-winking synkinesis of patients with Marcus-Gunn syndrome needs to be treated surgically.Levator excision combined frontal muscle suspension can treat moderate and severe jaw winking synkinesis very well for patients with Marcus-Gunn syndrome.