垂直斜视手术对复发性上睑下垂睑裂高度影响的探讨

Discussion of vertical strabismus surgery influence the width of palpebral fissure of recurrent ptosis

目的观察垂直斜视矫正术后,复发性上睑下垂睑裂的变化,探讨伴有垂直斜视的复发性上睑下垂患者的手术方案选择。方法回顾分析我院2013年至2016年,12例(15只眼)伴有垂直斜视的复发性上睑下垂患者,根据垂直斜视的不同类型采取不同手术方式。2例合并DVD综合征的外斜视,在矫正外斜的同时行上直肌后徙;4例外斜V征,行水平斜视矫正联合双眼下斜肌断腱术;1例眼球后退综合征,行内外直肌后徙+下斜肌断腱术;4例双上转肌麻痹,行患眼下直肌后徙+上直肌缩短;1例下直肌麻痹,行患眼上直肌后徙+下直肌缩短。术后观察睑裂高度的变化。结果随访6~24个月,11例垂直斜视矫正后,睑裂较术前提高(2.27±0.59)mm,睑裂高度(7.33±0.90)mm;1例垂直斜视矫正后,睑裂较术前提高1 mm,睑裂高度6 mm。12例患者垂直斜视矫正后复发性上睑下垂均明显改善。结论通过本组12例患者总结,对复发性上睑下垂应认真分析复发的原因,不是盲目再次行上睑下垂矫正术,应仔细检查眼位,如合并有垂直斜视,明确垂直斜视类型,如DVD综合征、A-V型斜视、动眼神经麻痹、眼球后退综合征、双上转肌麻痹、下直肌麻痹等应先行垂直斜视矫正,垂直斜视矫正后,上睑下垂得以明显改善,效果满意。术后观察3~6个月斜视度稳定后,如残存上睑下垂,根据上睑下垂的程度再选择是否行上睑下垂矫正手术。手术时根据上直肌功能和Bell现象选择额肌瓣悬吊术或提上睑肌缩短术,以减少上睑下垂术后复发几率和避免暴露性角膜炎的发生。

Objective Observe the changes of the width of palpebral fissure after strabismus surgery,and discuss the selection of a personalized operative plan in recurrent ptosis with vertical strabismus. Methods A retrospective analysis was made on the clinical data and follow up of 12 recurrent ptosis（ 15 eyes） with vertical strabismus patients treated in from 2013 - 2016 in the first people＇s hospital of Xuchou,chose different selection of a personalized operative plan according to the vertical strabismus type： 2 DVD syndrome with exotropia patients have operative plan of horizontal strabismus surgery and superior rectus recession; 4 V pattern exotropia patients,have operative plan of horizontal strabismus surgery and disinsertion of the inferior oblique muscle; 1 Duane retraction syndrome patient,have operative plan of medial rectus recession and the disinsertion of inferior oblique muscle; 4 Double elevator dysfunction patients,have operative plan of inferior rectus resection and superior rectus muscle resection; 1 inferior rectus paralysis patients,have operative plan of superior rectus muscle recession and inferior rectus resection. Observe the changes of the width of palpebral fissure after strabismus surgery. Results After 6 m（ month） - 24 m follow-up,the width of palpebral fissure increased about 2. 27 ± 0. 59 mm after strabismus surgery in 12 patients,the width of palpebral fissure 7. 33 ± 0. 90 mm; the width of palpebral fissure of 12 patients increased after strabismus surgery. The difference was statistically significant.（ P〈0. 05）.Conclusions The cause of relapse should be analyzed carefully,and do not redo correction of complete blepharoptosis in a hurry. The patients who recurrent ptosis with vertical strabismus should be cleard vertical strabismus type,such as： DVD syndrome、A-V pattern strabismus etc. and have the operation of vertical strabismus correction first. In this study,we found that vertical strabismus correction could significantly increase the height of the eyelid the width of palpebral fissure. After 3 m - 6 m followup,the operation effects of treatment is satisfactory. Some patients can avoid re operation of ptosis. A few patients were decided whether to operate ptosis according to the degree of ptosis. The author thinks,Compared with operative correction of blepharoptosis first,taken this timing of the operation could be effectively avoided the mistakes of operative type and operative number selection which lead to the risk of exposed keratitis.