比较额肌瓣悬吊术和联合筋膜鞘悬吊术治疗先天性重度上睑下垂前后的眼表变化

Ocular surface changes after conjoint fascial sheath suspension or frontal muscle flap suspension in the treatment for severe congenital ptosis

目的比较额肌瓣悬吊术和联合筋膜鞘悬吊术治疗先天性重度上睑下垂前后的眼表变化。方法41例(48只眼)5~86岁的先天性重度上睑下垂患者中,行额肌瓣悬吊术(A组)者21例(21只眼),行联合筋膜鞘悬吊术(B组)者20例(27只眼),分别在术前及术后7 d、1个月、3个月进行泪膜破裂时间测定(BUT)、泪液分泌实验(SIt)和角膜荧光染色(FL)检查,观察眼表变化。结果手术前后BUT、SIt检查结果无明显变化(P>0.05),但术后7 d、1个月FL评分高于术前(P<0.05)。两种术式之比较,除术后7 d BUT两者比较有统计学差异(P<0.05)外,余手术前后BUT、SIt和FL评分差异无统计学意义(P>0.05)。结论对先天性重度上睑下垂选择不同手术方式并不影响患者的BUT、SIt,但术后早期需要密切观察有无角膜上皮的损害。

Objective To compare the ocular surface changes after conjoint fascial sheath（ CFS） suspension or after frontal muscle flap suspension as the treatment for severe congenital ptosis. Methods Forty-one patients（ 48 eyes）with severe congenital ptosis underwent frontal muscle flap suspension（ group A,20 cases,21 eyes） and conjoint fascial sheath（ CFS） suspension（ group B,21 cases,27 eyes）. Patients were followed up for 3 months. Break-up time（ BUT）,Schirmer test（ SIt） and fluorescein（ FL） were assessed. Results Compared to pre-operative levels,BUT and SIt were not significantly changed but FL score was significantly higher on 1 week and 1 month（ P〈0. 05）. There were no significant differences in BUT,SIt and FL between the two groups except BUT score on the 7th day. Conclusions The two treatments had similar effects on ocular surface. But we should closely monitor corneal epithelium damage after the surgery.