伴假性Graefe征动眼神经麻痹后上睑下垂三例治疗观察

Treatment of blepharoptosis with pseudo-Graefe phenomenon caused by oculomotor nerve paralysis:report of three cases

目的探讨外因致单侧动眼神经麻痹后假性Graefe征伴上睑下垂的治疗方法。方法2014年7月至2017年7月,吉林大学第二医院眼表疾病与眼整形美容科收治3例外因致单侧动眼神经麻痹后假性Graefe现象患者,男2例,女1例,年龄分别23、32、15岁。均用改良上睑提肌缩短术,术后观察上睑缘高度、重睑弧度、眼球运动变化及相应的睑缘高度变化、睑裂闭合情况及暴露性角膜炎情况。结果1例患者术后上睑缘高度良好,2例动眼神经麻痹伴重度上睑下垂患者上睑缘未达正常高度。3例患者重睑弧度良好,眼球运动与术前无明显变化,中度上睑下垂睑裂闭合欠佳,重度上睑下垂闭合良好,无暴露性角膜炎发生。结论改良上睑提肌缩短术治疗单侧动眼神经麻痹后出现假性Graefe现象,中度上睑下垂患者效果较好,重度上睑下垂患者效果欠佳。

Objective To explore the treatment of unilateral blepharoptosis caused by oculomotor nerve paralysis with pseudo-Graefe phenomenon after craniocerebral trauma or operation.Methods Three patients suffered from blepharoptosis caused by oculomotor nerve paralysis with pseudo-Graefe phenomenon were collected in this study and the modified levator resection technique was applied to correct ptosis.The observation index after operation included the height of upper palpebral margin,the radian of double eyelid,the change of eye movement and the corresponding upper eyelid height,the eye closure function and the incidence of exposure keratitis.Results One case of oculomotor nerve palsy with moderate ptosis achieved an ideal height of upper eyelid after surgery,two cases of oculomotor nerve palsy with severe ptosis were undercorrection.All the three patients had smooth double eyelid radian,no obvious change of eye movement and corresponding upper eyelid height compared with preoperative.The two severe ptoses could close eyes well,but the moderate ptosis patient couldnot close eyes completely.Conclusions The technique of modified levator resection is an effective method to treat the moderate ptosis caused by oculomotor nerve paralysis with pseudo-Graefe phenomenon,but the results are unfavorable in the treatment of severe ptosis.