先天性上睑下垂屈光状态及提上睑肌腱膜的病理分析

Analysis of the refractive state of congenital ptosis and the pathology of levator aponeurosis

目的 探讨先天性上睑下垂的屈光状态及提上睑肌腱膜的病理改变。方法 选择进行手术治疗的先天性上睑下垂27例,按照肌力将其分为重度上脸下垂为17例,中度上脸下垂直为10例。27例患者均进行提上睑肌缩短术,将截取的提上睑肌腱膜做HE染色,分析屈光不正与弱视的关系及提上睑肌腱膜的病理改变。结果 27例先天性上睑下垂中19例屈光不正,患病率70.4%,其中近视10例,占37%;远视4例,占14.8%;散光14例,占51.9%;弱视9例,占47.4%。不同上睑下垂之间屈光不正及弱视患病率差异无统计学意义(P>0.05);不同程度上睑下垂的提上睑肌腱膜中肌纤维数量及完整性,与间质异常结缔组织分布差异均有统计学意义(Z=4.787,P<0.05;Z=11.249,P<0.05)。重度先天性上睑下垂术中可见提上睑肌腱膜被大量的异常韧带牵拉限制,病理切片观察异常韧带为纤维结缔组织及胶原组织。结论 先天性上睑下垂散光及弱视发病率较高,提上睑肌腱膜均存在不同程度的发育不良,这是先天性上睑下垂最主要的发病机制,而异常韧带的牵拉限制也可能是重度先天性上睑下垂的重要发病机制之一。

Objective To investigate the refractive state of congenital ptosis and the pathological changes of levator aponeurosis.Methods Twenty-seven cases of congenital ptosis who underwent surgical treatment were selected, including 14 males and 13 females, aged from 4 to 38 years, with the average age of(18.11±8.67)years.According to the muscle strength, they were divided into 17 severe cases and 10 moderate cases.All patients underwent shortening of levator aponeurosis, and the hematoxylineosin staining was performed.The relationship between ametropia and amblyopia and pathological changes of aponeurosis of levator aponeurosis in 27 cases were analyzed.Results Among the 27 cases of congenital ptosis, 19 cases had ametropia(70.4%),10 cases of myopia(37%),4 cases of hyperopia(14.8%)and 14 cases of astigmatism(51.9%).Amblyopia occurred in 9 cases(47.4%).There was no significant difference in the prevalence of ametropia and amblyopia among different ptosis(P>0.05).The number and integrity of muscle fibers in the aponeurosis of levator aponeurosis of different degrees of ptosis were significantly different from the distribution of connective tissue in the abnormal interstitial tissue(Z=4.787,11.249,P<0.05).In severe congenital ptosis, the aponeurosis of the upper eyelid was limited by a large number of abnormal ligaments.According to the pathological section, the abnormal ligaments were fibrous connective tissue and collagen tissue.Conclusion Congenital blepharoptosis has a high incidence of astigmatism and amblyopia.The levator aponeurosis has different degrees of dysplasia in moderate and severe congenital ptosis, which may be the main pathogenesis of congenital ptosis.The limitation of abnormal ligaments may be one of the important pathogenesis of severe congenital ptosis.