上睑下垂手术治疗前后的眼表变化

Ocular surface changes after ptosis surgery in patients with congenital ptosis

目的探讨上睑下垂手术治疗前后的眼表变化。方法先天性上睑下垂患者50例(68只眼)中,行额肌肌瓣悬吊术(悬吊组)者33例(45只眼),行经皮提上睑肌缩短术(缩短组)者17例(23只眼),观察患者术前及术后7d、1个月和3个月时眼表变化。包括泪液分泌试验(ST)、泪膜破裂时间(BUT)、泪眼河线高度(TMH)和角膜荧光素染色(FL)。结果术后1个月失访4例(4只眼),其余46例(64只眼)均完成最少3个月随访。46只眼在术后得到完全矫正或基本矫正。3只眼矫正不足;19例眼过矫。眼睑均能自然闭合,未发生暴露性角膜炎等并发症。手术前后泪液分泌试验(ST)、泪膜破裂时间(BUT)和泪眼河线高度(TMH)检测结果均无明显变化(P>0.05);仅术后7d和术后1个月时的FL评分明显高于术前(P<0.05)。两种术式患者手术前后ST、BUT和FL差异均无统计学意义(P>0.05)。结论手术治疗对先天性上睑下垂患者的泪液分泌量和泪膜破裂时间无明显影响;但需要注意术后早期患者角膜上皮存在一定程度损害。

Objective To explore the ocular surface changes after ptosis surgery in patients with congenital ptosis. Methods Fifty patients（68 eyes） with congenital ptosis underwent corrective surgery of frontal muscle muscle flap suspension（group A, 33 cases, 45 eyes） and eyelid muscle shortening（group B, 17 cases,ga eyes）. The ocular surface changes were followed up on the 7th day and in the 1st and 3rd month after operation, which included Schirmer test（ST）, berak-up time（BUT）, tears meaiscus height（TMH） and fluorescein（FL）. Results A total of 46 cases（64 eyes） received a complete postoperative follow-up for at least 3 months. A complete correction of ptosis was obtained in 46 eyes. The correction of ptosis was incomplete in 3 eyes and over correction occurred in 19 eyes, which could close spontaneously without any complications such as exposure keratitis. Compared to before, the ST,TMH and BUT were not significantly changed after surgery（P〉0. 05）, but FL score was higher on the 7th day and in the jst month after surgery （P〈0. 05）. The ST, BUT and FL after surgery were not significantly different between groups of A and B（P〉0.05）. Conclusion Surgical treatment of congenital ptosis does not impair tear secretion and the time of tear film rupture. But attention should be paid to a certain degree of corneal epithelium damage in early postoperative time.