联合筋膜鞘悬吊术治疗重度上睑下垂临床分析

Clinical analysis of conjoint fascial sheath suspension in treatment of severe blepharoptosis

目的探讨联合筋膜鞘(CFS)悬吊术治疗重度上睑下垂的临床疗效。方法回顾性分析2016年7月至2018年9月在海军军医大学(第二军医大学)长征医院行CFS悬吊手术治疗的43例(68眼)重度上睑下垂患者的临床资料,评价CFS悬吊术治疗重度上睑下垂的效果。评价指标包括角膜中央反射光点至上睑缘中心距离(MRD1)及改善值、睑缘弧度,重睑线成形及并发症。术后随访时间为3~12个月。结果术后3个月,术眼的MRD1平均改善值为(3.84±0.55)mm,上睑下垂程度较术前改善(P<0.01)。依据MRD1改善程度判断,满意66眼(97.06%,66/68),改善2眼(2.94%,2/68),术眼睑缘对称、弧度自然。术后1周患者上睑即可恢复部分活动范围,术后3个月所有患者上睑均可完全闭合。术后并发症少,早期有2例患者发生暴露性角膜炎,局部药物治疗后痊愈。所有患者均未出现眼睑内外翻、倒睫、眼球运动障碍、复视等其他并发症。结论CFS悬吊可有效矫正重度上睑下垂,同时具有外观好、活动自然、创伤小、易重复、并发症少、疗效满意度高等优点,具有临床推广价值。

Objective To evaluate the clinical effect of conjoint fascial sheath(CFS)suspension in treatment of severe blepharoptosis.Methods A total of 43 patients(68 eyes)with severe blepharoptosis were treated with CFS suspension in Changzheng Hospital of Naval Medical University(Second Military Medical University)from Jul.2016 to Sep.2018.The clinical data of the 68 eyes with severe blepharoptosis were retrospectively analyzed.The correction effect of this method was evaluated by the margin reflex distance(MRD1)and its improvement,the radian of eyelid margin,the shaping of double eyelid line and complications.The patients were followed up for 3-12 months.Results Blepharoptosis was effectively corrected after CFS suspension.Three months after operation,MRD1 was improved by(3.84±0.55)mm and blepharoptosis was significantly improved versus before operation(P<0.01).According to MRD1 improvement,66 eyes(97.06%,66/68)were satisfactory and 2 eyes(2.94%,6/68)were improved,with the upper eyelid margin being symmetrical and the radian being natural.The upper eyelid regained part of the movement one week after operation;and 3 months after operation,all patients could completely close the eyes.There were few postoperative complications:2 cases had exposed keratitis in the early stage,which was cured after drug treatment;and there were no other complications such as eyelid ectropion,trichiasis,eye movement disorder,or diplopia.Conclusion CFS suspension is effective for correction of severe blepharoptosis,with the advantage of good appearance,natural activity,minor trauma,easy repetition,less complications,and high satisfaction rate with curative effect,and it is worth popularizing in clinic.