手术矫正真性正负眼睑综合征1例

Surgical correction of true plus-minus lid syndrome: a case report

真性正负眼睑综合征是一种罕见的疾病,主要临床表现为一侧上睑下垂,另一侧上睑非代偿性退缩。以往报道的病例均为获得性,而该文报道了1例非获得性真性正负眼综合征病例,患者为26岁女性,既往体健,无其他基础疾病、手术及外伤史,年幼时双侧上睑即不对称:左侧上睑中度下垂,右侧上睑退缩,一直未予治疗。2022年3月患者就诊于南京中医药大学附属南京医院(南京市第二医院)整形外科,左侧行上睑提肌缩短前徙术,右侧行上睑提肌腱膜松解延长术,术后17个月复诊,双侧角膜暴露率基本对称,整体效果满意。同时,作者通过回顾文献探讨了真性及假性正负眼综合征的症状、体征、鉴别诊断,并对该例患者的发病机制进行了推断,有助于手术方式的选择。

True plus-minus lid syndrome is a rare clinical phenomenon characterized by ptosis on one side of the upper eyelid and uncompensated retraction on the other side.The reported cases in the past were all acquired plus-minus lid syndrome cases.This article presented a 26-year-old female patient with true plus-minus lid syndrome,who was in good health with no history of other underlying diseases,surgery or trauma.Her upper eyelid had been asymmetrical since childhood,showing retraction on the right and mild ptosis on the left,and it was left untreated.In March 2022,the patient was admitted to the Department of Plastic Surgery at the Second Hospital of Nanjing,Nanjing University of Chinese Medicine.The levator muscle of the upper eyelid was shortened on the left side,and the levator muscle of the upper eyelid was released and lengthened on the right side by surgery.After a 17-month follow-up,the bilateral corneal exposure rate was basically symmetrical,and the operative effect was satisfactory.The author also discussed the symptoms,signs,and differential diagnosis of true and pseudo plus-minus lid syndrome by reviewing the literature and inferred the pathogenesis of this case,which is helpful for selecting surgical methods.