Evaluation of the Levator Palpebrae Superioris Muscle Plication in the Treatment of Ptosis (About 12 Cases)

Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe congenital ptosis, and the second is of an aesthetic nature, representing the main reason for consultation. The aim of this work is to evaluate the interest of the levator palpebrae superioris muscle plication in the ptosis surgery. Materials and Methods: We collected 12 patients who received a correction of their ptosis by plication of the levator palpebrae superioris muscle over a period of 3 years from January 2012 to December 2014. Result: The mean age at treatment was 22 years;the ptosis was congenital in 8 cases, and acquired in 4. The ptosis was major in 67% and moderate in 33% of the cases. Muscle plication was the basic surgical technique in all patients in our series. The function and aesthetic results were satisfying in 6 cases (50%), good in 4 cases (34%), acceptable in 1 case and bad in 1 case (8%). Discussion: The comparative study has shown that the plication of the levator palpebrae superioris muscle is a possible alternative for the correction of ptosis whatever the type of ptosis with results comparable to the reference technique compared to the degree of correction, whereas the operative follow-up is simpler and more minor complications. Conclusion: The surgical treatment of ptosis should be done after a systematic clinical examination and after very precise indications. However, the plication of the levator muscle of the upper eyelid has shown its functional and aesthetic efficiency in congenital ptosis and in the ptosis of the adult.

Accurate Application of the Levator Palpebrae Superioris Anterior Migration and Shortening Technique in Blepharoptosis Correction Surgery

Background Accurate preoperative evaluation of the levator palpebrae superioris(LPS)strength is required for specific calculation of anterior migration or shortening.This information serves as a surgical reference for more accurate correction of ptosis.Methods Between June 2017 and June 2019,155 eyes of 97 patients were studied.Patients were divided into the following 3 groups based on the ptosis degree:mild(28 cases),moderate(53 cases),and severe(16 cases).The LPS strength was evaluated preoperatively and used to calculate LPS anterior migration and shortening.The LPS aponeurosis and Müller’s muscle(L-M)complex was separated from the upper margin of the tarsal plate to the calculated height according to the levator muscle suspension system retention approach.The complex was subsequently fixed to the planned tarsal plate location.The upper eyelid margin(UEM)height,eyelid morphology,eyelid closure,eye symmetry,exposure keratitis status,and patient satisfaction were evaluated at 1 week and at 1 and 6 months postoperatively.Results In all cases,the UEM positions were normal,and only patients with severe ptosis exhibited lagophthalmos in the early posterative period.Six months postoperatively,13%of eyes in the severe group had residual ptosis;all mild and moderate cases exhibited good surgical outcomes.The eyelids closed well with no exposure keratitis.All patients were satisfied with the eyelid contour.Conclusions Accurate LPS anterior migration and aponeurosis shortening can eliminate various factors affecting surgical blepharoptosis treatment.These procedures not only reduce operation time but also enhance the stability of postoperative correction.

Superior rectus/levator complex in acquired anophthalmic socket repaired with spheric implant—a computed tomography scan and topographic study

AIM:To determine whether the levator palpebrae superioris(LPS)/superior rectus(SR)muscle complex,can influence the position of the upper lid and fornix in acquired anophthalmic sockets.METHODS:This comparative non-randomized and non-interventional study included retrospective data of 21 patients with unilateral acquired anophthalmic sockets repaired with spheric implants.High-resolution computed tomography(CT)measurements of the LPM/SR muscle complex and clinical topographic position of the upper lid,superior and inferior fornix depth in primary gaze position were evaluated.Demographic data were presented as frequency and percentage proportions and quantitative variables comparing the socket measurements with the normal contralateral orbit was statistically analyzed using non-parametric tests considering P<0.05.RESULTS:The anophthalmic orbits had a significantly shorter LPS length(P=0.01)and significantly thicker SR(P=0.02)than the normal orbit.Lagophthalmos was present in anophthalmic sockets but not in normal orbits(P=0.002),while levator function was normal in both(P>0.05,all comparisons).The superior fornix depth was similar in the anophthalmic socket and the contralateral normal orbit(P=0.192)as well the inferior fornix depth(P=0.351).CONCLUSION:Acquired anophthalmic sockets repaired with spheric implants have shorter LPS,thicker SR,and more lagophthalmos than normal orbits.The relationship of the LPS and SR with other orbital structures,associated with passive or active forces acting in the final position of the lids and external ocular prosthesis should be further investigated.

改良联合筋膜鞘悬吊联合提上睑肌复合体缩短术在重度上睑下垂中的应用

目的 研究改良联合筋膜鞘(conjiontfascial sheath,CFS)悬吊联合提上睑肌复合体缩短术治疗重度上睑下垂的临床有效性。方法 选取2022年1月至2023年5月北京丰台右安门医院医疗美容科收治的采用改良CFS悬吊联合提上睑肌复合体缩短术治疗的18例重度上睑下垂患者为观察组,另选择同期采用标准的CFS悬吊联合提上睑肌复合体缩短术治疗的18例重度上睑下垂患者为对照组。观察组手术方法对标准术式进行改良,即不直接在睑板上缘切开分离提上睑肌腱膜,而改为在上横韧带上方剪开提上睑肌腱膜并暴露CFS。比较两组患者在术后睑裂垂直高度(palpebral fissure height,PFH)和边缘反射距离(margin regles distance 1,MRD1)、术后并发症发生率及满意度之间的差异。结果 术后1个月、3个月和12个月测量两组患者的PFH值及MRD1值,进行组间比较,差异无统计学意义(P>0.05)。观察组并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。观察组的满意度显著高于对照组,差异有统计学意义(P<0.05)。结论 改良CFS悬吊联合提上睑肌复合体缩短术治疗重度上睑下垂,具有安全高效、并发症少、患者满意度高等优势,此方法值得在临床推广应用。

A new technique for correction of iatrogenic upper eyelid retraction by using a composite flap of the orbicularis muscle and fascia on the anterior surface of the tarsal plate

Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC)on the anterior surface of the tarsal plate.This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS),which can achieve a good correction for post-blepharoplasty retraction.Methods:We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019.The OFC was used to replace the missing part of the LPS,and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted.Postoperative outcome measurements included postoperative binocular symmetry,double eyelid smoothness,eyelid fullness,margin reflex distance(MRD1),degree of eyelid closure,and exposure keratitis.The patients were followed-up at seven days,one month,and six months postoperatively.Results:One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively,with the upper eyelid margin located at the upper edge of the pupil.The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin.Other observational indicators were satisfactory,including binocular symmetry,double eyelid fluency,and eyelid fullness.During the follow-up,no exposure keratitis was identified.The MRD1 indexes after the operation were significantly different(P<0.001)from those before the procedure.Conclusions:Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.

超脉冲CO_2激光治疗眼睑缘痣细胞痣的疗效观察

目的:探讨超脉冲CO2激光治疗眼睑缘痣细胞痣的疗效与安全性。方法:使用超脉冲CO2激光治疗仪在眼罩保护,局部注射麻醉下,采用能量18～35mJ/cm2,频率20～30Hz治疗眼睑缘痣细胞痣42例。结果:随访3个月后其中39例皮损完全消退,无复发,3例皮损明显缩小,残留芝麻大小黑点,再次治疗后皮损消失。总有效率100%,患者满意,无不良反应及副作用。结论:采用超脉冲CO2激光治疗眼睑缘痣细胞痣操作简单、安全,效果显著,无副作用。

提上睑肌腱膜瓣—额肌吻合术治疗重度上睑下垂

目的:观察提上睑肌腱膜瓣—额肌吻合术矫治重度上睑下垂的治疗效果。方法:对22例(28眼)先天性重度上睑下垂患者采用上睑皮肤双切口,制作提上睑肌腱膜瓣及额肌瓣,经眶膈后隧道将提上睑肌腱膜瓣于眉部辅助切口与额肌瓣吻合。结果:随访3mo～2a。21例(27眼,96%﹚术后效果良好,1例(1眼,4%﹚轻度矫正不足。结论:该术式具有矫治效果好、术中额肌剥离范围小、损伤轻、术后重睑形成自然美观等优点。是重度上睑下垂理想的手术方式。

上睑提肌腱膜折叠矫正上睑下垂术后的中面部美学比例改变分析

目的测量接受过上睑提肌折叠的重睑术患者眉上缘至下睑缘的距离(L1)和下睑缘至鼻下缘的距离(L2)之比,分析术前术后中面部美学比例的改变。方法收集我科2015年12月至2016年10月21例接受该手术患者术前术后照片,设为研究组。利用Adobe Photoshop测量术前术后L1和L2之比J。另收集20例中国地区女明星正面照片,设为对照组,同法测量J值,分析两组统计学差异。结果研究组中术前J1值平均为0.746,术后J2为0.657,对照组J3为0.667,研究组术前术后J值及研究组术前与对照组J值差异具有统计学意义。研究组术后和对照组J值差异无统计学意义。研究组术后L1/L2的比值接近对照组比值,更接近符合黄金分割的美学比例。结论术后患者L1缩短,和L2之比更符合黄金分割的美学比例,中面部美学比例更加和谐。对于此类患者的手术沟通及预期效果评估,也可以从中面部美学比例改变的角度进行分析。

上睑肌缩短术和额肌瓣悬吊术矫治先天性中度上睑下垂临床疗效和安全性

目的观察上睑肌缩短术和额肌瓣悬吊术矫治先天性中度上睑下垂患者的临床疗效和安全性。方法对我院2010年5月至2012年5月收治的108例先天性中度上睑下垂患者进行手术治疗,其中56例采用上睑肌缩短术治疗(A组),52例采用额肌瓣悬吊术治疗(B组),比较两种不同手术术式矫治的临床疗效以及不良反应发生情况。结果 A组中53例患者的手术治疗效果较好,有效率为94.6%,B组有效率为71.2%,两组间的差异具有统计学意义(P<0.05)。大部分患者术后视力均有不同程度提高,但A组术后并发症的发生率(7.1%)明显低于B组(23.1%),其差异具有统计学意义(P<0.05)。结论上睑提肌缩短术是矫治先天性中度上睑下垂的良好方法。

提上睑肌缩短术在治疗中重度先天性上睑下垂中的应用

目的:观察应用提上睑肌缩短术治疗中重度先天性上睑下垂的效果。方法:对39例(56眼)中重度先天性上睑下垂患者采用经皮肤-睑结膜入路提上睑肌缩短术。并对术后效果进行随访观察。结果:本组39例(56眼)随访2～18mo,除2眼矫正不足外,余均获得良好效果。上睑缘弧度及双重睑形成良好,术后仅部分病例早期有轻度睑裂闭合不全,无暴露性角膜炎等并发症发生。结论:提上睑肌缩短术可适用于中重度先天性上睑下垂患者,在矫正畸形和改善外观方面均能达到良好的效果。

应用射频技术治疗皮脂腺囊肿的疗效分析

目的观察XL-射频皮肤治疗仪(解放军总医院第一医学中心康复医学中心研制)放大镜下消融治疗皮脂腺囊肿的临床疗效。方法在头戴式放大镜下,使用XL-射频皮肤治疗仪消融微切64例皮脂腺囊肿,其中面部42例(鼻唇部4例,前额部4例,颞区5例,两颊14例,下颌及颏部2例,眼周13例),头部2例,躯干12例(颈部6例,胸前区5例,背部1例),四肢8例(上肢5例,下肢3例)。囊肿长径0.2~2.9 cm。手术切口1.5~3 mm,不缝合。随访观察6~60个月。结果64例治愈,其中59例(92.2%)1次治疗治愈,5例(7.8%)术后部分残留,第2次治疗治愈。随访期内,有效率98.4%,复发率1.6%。60例无肉眼可见的手术瘢痕,4例肉眼可见微小瘢痕。所有切口均达到甲级愈合。结论XL-射频皮肤治疗仪治疗皮脂腺囊肿是一项安全、精准、有效的治疗技术,特别是对于头面部、睑缘及关节等部位的皮脂腺囊肿。

上直肌联合上睑提肌腱膜缩短术治疗中重度上睑下垂

目的:探讨上直肌联合上睑提肌腱膜缩短术矫正中重度上睑下垂的临床疗效。方法:回顾性统计分析2014年1月-2017年5月于本院行上直肌联合上睑提肌腱膜缩短术的74例中重度上睑下垂患者的病例资料,观察患者的临床疗效及术后并发症发生情况。结果:本组74例患者,过度矫正2例,矫正不足1例;术后上眼睑肿胀3例,给予换药、理疗5d后缓解;上眼睑血肿1例;眼睑闭合不全1例。平均随访10个月,均无复发。结论:上直肌联合上睑提肌腱膜缩短术治疗中重度上睑下垂疗效确切,并发症少,值得临床推广。

联合筋膜鞘结合提上睑肌矫正复发性重度上睑下垂的临床研究

目的:探讨应用联合筋膜鞘悬吊睑板,结合提上睑肌缩短提升,治疗复发性重度上睑下垂的临床效果。方法:应用联合筋膜鞘悬吊睑板,结合提上睑肌缩短提升,治疗复发性重度上睑下垂,共计30例35只眼。结果:随访6个月~3年,其中满意30只眼,改善5只眼,对4只改善眼做了2次调整;有1只改善后不愿意做再次调整。双睑睑裂基本对称,重睑弧度自然。结论:应用联合筋膜鞘悬吊睑板,结合提上睑肌缩短提升,治疗复发性重度上睑下垂,手术操作相对简单,具有创伤小,可重复性强,并发症少等优点,能有效地提高上眼睑高度。

应用眶隔筋膜瓣与额肌瓣治疗重度上睑下垂的美容学意义探讨

目的探讨一种矫治重度上睑下垂的美容有效方法。方法术中制作一蒂在眶隔筋膜与提上睑肌结合部之上的眶隔筋膜瓣,在眉区分离额肌筋膜瓣,将额肌筋膜瓣插入眶隔筋膜与提上睑肌之间,三瓣重叠牢固缝合,悬吊上睑矫正上睑下垂。结果采用此法对12例12侧重度上睑下垂进行治疗,随访6~18个月,平均1年,其中,10只眼睛满意,1只好转,1只眼睛上睑外侧偏低重新修复后正常。结论利用眶隔筋膜、额肌、提上睑肌腱膜三瓣吻合术矫正重度上睑下垂,上睑悬吊牢靠,眼部上提接近生理,睑缘弧度自然,达到美容治疗双重功效,是一种可以推广的美容方法。

改良上睑提肌缩短术治疗上睑下垂

目的:为轻度上睑下垂的治疗提供更为简单有效更符合生理要求的方法。方法:采用上睑提肌折叠缩短前移的改良新术式治疗轻度上睑下垂。结果:1996年以来共治疗63例,随访3～6个月,效果好,创伤小。结论:该法适用于轻度上睑下垂、上睑提肌肌力中等以上的患者。

提上睑肌缩短术治疗重度先天性上睑下垂

目的:探讨采用提上睑肌缩短术治疗重度先天性上睑下垂的效果及可行性。方法:对30例(34眼)患重度先天性上睑下垂患者,分别在局麻下行经皮肤面的提上睑肌缩短术,术前均进行详细的检查以除外垂直肌麻痹,jew-wink现象,重症肌无力等,bell(+)现象,上睑下垂程度用berke法:均>4mm以上,提上睑肌功能均<4mm以下,缩短量为18～24mm。结果:30例(34眼)重度先天性上睑下垂患者经用提上睑肌缩短术治疗均获满意效果,上睑缘位于角膜缘下1～3mm,双侧睑裂大小,重睑高度基本一致,睑缘弧度自然流畅,睑闭合无角膜暴露,皱额耸眉姿态消失,随诊0.5～3a,效果满意。结论:经皮肤面的提上睑肌缩短术术野暴露好,可最大限度的充分游离提上睑肌,且年龄小,肌肉弹性好,矫正度数大,可以矫正重度先天性上睑下垂,且效果确实,可行。

上睑联合筋膜鞘悬吊结合提上睑肌缩短术矫治中重度上睑下垂

目的:探讨上睑联合筋膜鞘悬吊结合提上睑肌缩短术矫正中重度上睑下垂的临床效果。方法:选取2016年1月-2018年5月笔者医院收治的中重度上睑下垂患者106例(113只眼),先天性或复发性中重度上睑下垂患者均采用上睑联合筋膜鞘(CFS)悬吊同时行提上睑肌缩短的方法进行矫正。术后6~12个月随访,进行满意度调查。结果:随访6~12个月,患者术后睁眼有力,眼睑及眼球活动自由协调。106例患者中99例满意、4例基本满意、3例不满意,满意率97.2%(103/106)。结论:采用上睑联合筋膜鞘(CFS)悬吊结合提上睑肌缩短术矫正中重度上睑下垂,术后眼睑活动自如,重睑弧度自然,安全可靠,并发症少。

A型肉毒毒素治疗眉外侧段与上睑外侧的老年性皮肤松垂

目的 探讨A型肉毒毒素注射治疗眉和上睑外侧老年性皮肤松垂的非手术治疗方法。方法 采用A型肉毒毒素注射治疗眉外侧段和上睑外侧皮肤松垂的面部老化求美者 ,对皱眉肌 ,降眉肌 ,眉中、外 1/ 3交界垂线内侧的额肌 ,外眦部眼轮匝肌行计量定点注射。结果 对 2 6例求美者 5 2侧眉和上睑外侧皮肤不同的松垂程度 ,经一次或二次注射后均得到了明显的改善。结论 A型肉毒毒素用于治疗眉和上睑外侧老年性皮肤的松垂 ,操作方法简单 ,安全有效。

两种治疗儿童先天性上睑下垂手术的比较

本文报告70眼（53例）3～13岁儿童先天性上睑下垂的手术，其中30眼应用上睑提肌缩短术，术后达正矫16眼（53．34％），40眼应用额肌悬吊术，术后达正矫33眼（82．50％）。比较二种手术的效果，得出额肌悬吊术优于上睑提肌缩短术。文中分析了缩短术效果差的原因；讨论了儿童上睑下垂手术的年龄，认为3～6岁合适。

眼睑整复手术中的睑缘再造

目的研究眼睑整复手术中睑缘再造的重要性及睑缘再造的手术方式。方法22例(22眼),分别采用不包括睑缘重建和包括睑缘重建的方式进行眼睑整复手术。结果眼睑整复时未进行睑缘再造者,多出现重建区皮肤面内卷进入结膜面,较少出现在重建区结膜面外卷进入皮肤面的情况。均有不等的角膜刺激症状,严重者角膜上皮损伤,形成角膜新生血管。眼睑整复同时进行睑缘再造者,术后睑缘逐步恢复平滑外观,未出现以上异常表现。结论睑缘重建是眼睑整复手术的重要组成部分。