先天性上睑下垂患儿术后角膜曲率及眼表变化的研究

Corneal curvature and ocular surface changes after operation in congenital ptosis

目的探讨先天性上睑下垂术后角膜曲率、眼表变化。方法2018年1月至2020年1月,武汉大学附属爱尔眼科医院眼整形科收治先天性上睑下垂患儿188例(194眼),男100例103眼、女88例91眼;单眼182例、双眼6例;年龄1~3(2.12±0.28)岁。根据病情分别给予额肌瓣悬吊术、提上睑肌缩短术、提上睑肌腱膜折叠术治疗。观察术后矫正效果、角膜曲率、眼表变化。结果3种术式矫正良好率差异无统计学意义(P>0.05)。术后3个月角膜曲率低于术前、术后7 d(P<0.05)。术后7 d荧光素染色评分高于术前和术后3个月(F=2910.05,P<0.05)。术后7 d泪膜破裂时间明显短于术前和术后3个月(F=758.12,P<0.05)。术前、术后7 d、术后3个月的泪液分泌试验差异无统计学意义(P>0.05)。术后3个月结膜充血评分低于术后7 d,术后3个月睑板腺功能障碍、睫毛角度异常发生率低于术后7 d(t=113.56,χ^(2)=11.02、11.46,P<0.05)。术后3个月角膜定点为中心,3、5 mm平均屈光度较术前增高(t=12.35、15.19,P<0.05)。结论额肌瓣悬吊术、提上睑肌缩短术、提上睑肌腱膜折叠术治疗先天性上睑下垂疗效相当,均可有效改善眼表、角膜曲率,可根据患儿病情选择合适的矫正方式。

Objective To observe the changes of corneal curvature and ocular surface after congenital ptosis.Methods A total of 188 patients with congenital blepharoptosis were treated with frontal muscle flap suspension,levator eyelid muscle shortening and fixation,and levator aponeurosis according to different conditions.The postoperative correction effect,corneal curvature,and ocular surface changes were observed.Results There was no significant difference in the good correction rate among the three methods(P>0.05).The corneal curvature at 3 months after operation was lower than that before operation and 7 days after operation(P<0.05).The fluorescein staining score at 7 days after operation was higher than that before operation and 3 months after operation(F=2910.05,P<0.05).The tear film rupture time at 7 days after operation was significantly shorter than that before operation and 3 months after operation(F=758.12,P<0.05).There was no significant difference in tear secretion test before operation,7 days after operation and 3 months after operation(P>0.05).The conjunctival congestion score at 3 months after operation was lower than that at 7 days after operation,and the incidence of meibomian gland dysfunction and abnormal eyelash angle at 3 months after operation was lower than that at 7 days after operation(t=113.56,χ^(2)=11.02,11.46,P<0.05).3 months after operation,the average diopters of 3 mm and 5 mm were higher than those before operation(t=12.35,15.19,P<0.05).Conclusions Frontal muscle suspension,levator eyelid muscle shortening and fixation,and levator aponeurosis are effective in treating congenital blepharoptosis,and can effectively improve the ocular surface and corneal curvature.Clinically,the appropriate one can be selected according to the condition of the child correction method.