Frontalis suspension

额骨悬吊
  • 文章类型: Journal Article
    这项研究的目的是前瞻性地评估新的微创(MINE)browlift技术,其可能具有出色的结果和最小的可见疤痕。
    将对2021年6月1日至2024年5月31日在HMC中接受browlift手术的患者的所有可用数据进行前瞻性观察性研究。我们的目标是包括至少50名患者。纳入标准是:有医学(即眉头下垂和面瘫)或美容适应症的患者,患者对荷兰语或英语有足够的理解,并愿意参加额外的研究特定的随访时间和填写问卷。排除标准为:未满18岁及既往眉毛或眼睑手术的患者。将使用VECTRA相机在术前和术后对患者进行拍照。
    手术后留下疤痕;眉毛运动的功能;眉毛下垂的矫正量,在VECTRA中测量;以月为单位的手术寿命;通过问卷调查评估的美学结果和手术的不利影响将被测量。
    数据库管理软件\'Castor\'将用于存储和收集问卷中的数据。医学研究伦理委员会发现这项研究没有资格提交给荷兰涉及人类受试者的医学研究法案(WMO)。将获得所有患者的书面同意。
    UNASSIGNED: The aim of this study is to prospectively evaluate the new minimal invasive (MINE) browlift technique with possibly superior results and minimal visible scarring.
    UNASSIGNED: A prospective observational study will be performed on all available data from patients who will undergo a browlift procedure in the HMC from 1 June 2021 till 31 May 2024. Our goal is to include at least 50 patients. Inclusion criteria are: patients with medical (i.e. brow ptosis and facial paralysis) or cosmetic indication, patients with sufficient understanding of the Dutch or English language and willingness to participate in extra study specific follow-up moments and filling in of questionnaires. Exclusion criteria are: less than 18 years of age and patients with previous brow or eyelid surgery. Patients will be photographed preoperatively and postoperatively using the VECTRA camera.
    UNASSIGNED: Scarring after procedure; functionality of eyebrow movement; amount of correction in brow ptosis, measured in VECTRA; longevity of procedure in months; aesthetic result as assessed by questionnaires and adverse effects of procedure will be measured.
    UNASSIGNED: The database management software \'Castor\' will be used to store and collect the data from the questionnaire. The Medical Research Ethics Committee found this study not eligible to be submitted to the Dutch Medical Research Involving Human Subjects Acts (WMO). Written consent will be obtained from all patients.
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  • 文章类型: Journal Article
    上眼睑是一种位置异常低的上眼睑。管理取决于严重程度,病因学,和提上掌肌(LPS)的功能。这篇综述评估了自体筋膜吊索(AFLS)在上睑下垂手术治疗中的成功。并发症和再手术/翻修率。在PubMed上进行了文献检索,谷歌学者PROSPERO,dynamed,DARE,EMBASE,科克伦,和BMJ数据库(PROSPERO注册:CRD42023475090),纳入30项研究(3690例患者和5059只眼)。患者的平均年龄为14.2岁,男女比例为1:0.7。共有2532只眼进行了带自体筋膜的筋膜吊带。平均随访时间32.6个月。筋膜吊带手术的反射距离1(MR1)边缘改善为2.79mm。涉及自体阔筋膜的手术并发症发生率为21.3%。最常见的并发症包括眩眼(19.8%),残余下垂(11.5%),和角膜损伤(10.4%)。再次手术率为13.4%。再手术最常见的适应症是美容,不对称(18%),眼睑折痕异常(30%),和上眼睑修剪(18%)。AFLS患者的总并发症发生率为20%(95%CI:6至35,p<0.01;I2=89%),而非AFLS患者为27%(95%CI:14至40,p<0.01;I2=90%)。AFLS在上睑下垂的手术治疗中是谨慎的。这篇综述的结果表明,与其他传统技术相比,它们的使用与相似的并发症发生率相关,但重复手术较少。上眼睑是一种位置异常低的上眼睑。管理取决于严重程度,病因学,和提上掌肌(LPS)的功能。这篇综述评估了自体筋膜吊索(AFLS)在上睑下垂手术治疗中的成功。并发症和再手术/翻修率。在PubMed上进行了文献检索,谷歌学者PROSPERO,dynamed,DARE,EMBASE,科克伦,和BMJ数据库(PROSPERO注册:CRD42023475090),纳入30项研究(3690例患者和5059只眼)。患者的平均年龄为14.2岁,男女比例为1:0.7。共有2532只眼进行了带自体筋膜的筋膜吊带。平均随访时间32.6个月。筋膜吊带手术的反射距离1(MR1)边缘改善为2.79mm。涉及自体阔筋膜的手术并发症发生率为21.3%。最常见的并发症包括眩眼(19.8%),残余下垂(11.5%),和角膜损伤(10.4%)。再次手术率为13.4%。再手术最常见的适应症是美容,不对称(18%),眼睑折痕异常(30%),和上眼睑修剪(18%)。AFLS患者的总并发症发生率为20%(95%CI:6至35,p<0.01|上眼睑异常低位。管理取决于严重程度,病因学,和提上掌肌(LPS)的功能。这篇综述评估了自体筋膜吊索(AFLS)在上睑下垂手术治疗中的成功。并发症和再手术/翻修率。在PubMed上进行了文献检索,谷歌学者PROSPERO,dynamed,DARE,EMBASE,科克伦,和BMJ数据库(PROSPERO注册:CRD42023475090),纳入30项研究(3690例患者和5059只眼)。患者的平均年龄为14.2岁,男女比例为1:0.7。共有2532只眼进行了带自体筋膜的筋膜吊带。平均随访时间32.6个月。筋膜吊带手术的反射距离1(MR1)边缘改善为2.79mm。涉及自体阔筋膜的手术并发症发生率为21.3%。最常见的并发症包括眩眼(19.8%),残余下垂(11.5%),和角膜损伤(10.4%)。再次手术率为13.4%。再手术最常见的适应症是美容,不对称(18%),眼睑折痕异常(30%),和上眼睑修剪(18%)。AFLS患者的总并发症发生率为20%(95%CI:6至35,p<0.01;I=89%),而非AFLS患者为27%(95%CI:14至40,p<0.01;I2=90%)。AFLS在上睑下垂的手术治疗中是谨慎的。这篇综述的结果表明,与其他传统技术相比,它们的使用与相似的并发症发生率相关,但重复手术较少。上眼睑是一种位置异常低的上眼睑。管理取决于严重程度,病因学,和提上掌肌(LPS)的功能。这篇综述评估了自体筋膜吊索(AFLS)在上睑下垂手术治疗中的成功。并发症和再手术/翻修率。在PubMed上进行了文献检索,谷歌学者PROSPERO,dynamed,DARE,EMBASE,科克伦,和BMJ数据库(PROSPERO注册:CRD42023475090),纳入30项研究(3690例患者和5059只眼)。患者的平均年龄为14.2岁,男女比例为1:0.7。共有2532只眼进行了带自体筋膜的筋膜吊带。平均随访时间32.6个月。筋膜吊带手术的反射距离1(MR1)边缘改善为2.79mm。涉及自体阔筋膜的手术并发症发生率为21.3%。最常见的并发症包括眩眼(19.8%),残余下垂(11.5%),和角膜损伤(10.4%)。再次手术率为13.4%。再手术最常见的适应症是美容,不对称(18%),眼睑折痕异常(30%),和上眼睑修剪(18%)。AFLS患者的总并发症发生率为20%(95%CI:6至35,p<0.01;I2=89%),而非AFLS患者为27%(95%CI:14至40,p<0.01;I2=90%)。AFLS在上睑下垂的手术治疗中是谨慎的。这篇综述的结果表明,与其他传统技术相比,它们的使用与相似的并发症发生率相关,但重复手术较少。I2=90%)在非AFLS患者中。AFLS在上睑下垂的手术治疗中是谨慎的。这篇综述的结果表明,与其他传统技术相比,它们的使用与相似的并发症发生率相关,但重复手术较少。|上眼睑是一种异常低的上眼睑。管理取决于严重程度,病因学,和提上掌肌(LPS)的功能。这篇综述评估了自体筋膜吊索(AFLS)在上睑下垂手术治疗中的成功。并发症和再手术/翻修率。在PubMed上进行了文献检索,谷歌学者PROSPERO,dynamed,DARE,EMBASE,科克伦,和BMJ数据库(PROSPERO注册:CRD42023475090),纳入30项研究(3690例患者和5059只眼)。患者的平均年龄为14.2岁,男女比例为1:0.7。共有2532只眼进行了带自体筋膜的筋膜吊带。平均随访时间32.6个月。筋膜吊带手术的反射距离1(MR1)边缘改善为2.79mm。涉及自体阔筋膜的手术并发症发生率为21.3%。最常见的并发症包括眩眼(19.8%),残余下垂(11.5%),和角膜损伤(10.4%)。再次手术率为13.4%。再手术最常见的适应症是美容,不对称(18%),眼睑折痕异常(30%),和上眼睑修剪(18%)。AFLS患者的总并发症发生率为20%(95%CI:6至35,p<0.01;I2=89%),而非AFLS患者为27%(95%CI:14至40,p<0.01;I2=90%)。AFLS在上睑下垂的手术治疗中是谨慎的。这篇综述的结果表明,与其他传统技术相比,它们的使用与相似的并发症发生率相关,但重复手术较少。
    Ptosis is an abnormally low-positioned upper eyelid. Management depends on severity, aetiology, and function of the levator palpebrae superioris muscle (LPS). This review evaluates the success of autogenous fascia lata slings (AFLS) in the surgical management of ptosis, together with complication and reoperation/revision rates. A literature search was conducted on PubMed, Google Scholar PROSPERO, Dynamed, DARE, EMBASE, Cochrane, and BMJ databases (PROSPERO registration: CRD42023475090), and 30 studies (3690 patients and 5059 eyes) were included. The average age of the patients was 14.2 years with a ratio of male:female patients of 1:0.7. A total of 2532 eyes had undergone a fascial sling with autogenous fascia lata. The average follow-up period was 32.6 months. Improvement in the margin to reflex distance 1 (MRD1) with fascial sling surgery was 2.79 mm. The rate of complications from surgery involving autogenous fascia lata was 21.3%. The most common complications included lagophthalmos (19.8%), residual ptosis (11.5%), and corneal damage (10.4%). The reoperation rate was 13.4%. Most common indications for reoperation were cosmetic, with asymmetry (18%), lid crease abnormalities (30%), and upper eyelid trimming (18%). The overall complication rate in AFLS patients was 20% (95% CI: 6 to 35, p < 0.01; I2 = 89%) versus 27% (95% CI: 14 to 40, p < 0.01; I2 = 90%) in non-AFLS patients. AFLSs are prudent in the surgical management of ptosis. The results of this review demonstrate that their use is associated with similar complication rates but fewer reoperations than other traditional techniques.
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  • 文章类型: Journal Article
    目的该研究的目的是评估使用膨体聚四氟乙烯(ePTFE)吊带进行先天性上睑下垂修复的额肌悬吊术后的短期和长期功能结果。方法回顾性分析,我们对2008年至2020年期间使用ePTFE吊带行额骨悬吊术的儿科患者进行了观察性病例回顾.通过盖子高度评估功能成功,盖子对称,和父母对美容结果的满意度。评估手术后的临床过程和长期功能结果。结果21例符合纳入标准并进行评估。随访时间13个月至11年,平均6年。一次手术后的功能成功率在术后早期和晚期为62%。21例中有6例(29%)由于矫正不足而在术后早期需要进行修正手术。3例(14%)并发感染和/或肉芽肿形成。如果在术后早期看到成功,则从长远来看没有上睑下垂复发的病例。结论ePTFE吊索仍然是额肌吊索修复严重先天性上睑下垂的理想选择。证明了长期的功能成功,具有令人满意的盖子对称性和可接受的美容结果。这对于三岁以下的患者来说是重要的考虑因素,不推荐使用自生材料。需要进行早期修正手术以进行矫正不足并不少见。目前的作者还证明了感染和/或肉芽肿形成的低但相当大的风险。
    Purpose The purpose of the study is to assess short- and long-term functional outcomes after frontalis suspension using expanded polytetrafluoroethylene (ePTFE) sling for congenital ptosis repair. Methods A retrospective, observational case review was conducted on pediatric patients who underwent frontalis suspension using ePTFE sling from 2008 to 2020. Functional success was assessed by lid height, lid symmetry, and parental satisfaction with the cosmetic outcome. Clinical course and long-term functional outcomes after surgery were assessed. Results Twenty-one cases met the inclusion criteria and were assessed. The follow-up time ranged from 13 months to 11 years (mean: six years). Functional success after one surgery was 62% at early and late postoperative periods. Six of 21 cases (29%) required revisional surgery in the early postoperative period due to undercorrection. Three cases (14%) were complicated by infection and/or granuloma formation. There were no cases of ptosis recurrence in the long term if success was seen in the early postoperative period. Conclusion ePTFE slings remain an excellent option for severe congenital ptosis repair with frontalis sling, demonstrating long-term functional success, with satisfactory lid symmetry and acceptable cosmetic outcome. This is of important consideration in patients younger than three years of age, where autogenous materials may not be recommended. The need for early revisional surgery for undercorrection is not uncommon. The current authors also demonstrate a low but considerable risk for infection and/or granuloma formation.
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  • 文章类型: Journal Article
    额骨悬吊术通常用于修复先天性上睑下垂和累及性上睑下垂功能差。已经使用各种不同的材料开发了用于此程序的移植物,每个都有优点和缺点。耳后筋膜移植可能在该手术中有益。本文报道了上睑下垂的手术效果,用耳后筋膜治疗的人,这是一种新的自体额悬吊技术。本病例系列研究针对2016年5月至2023年5月在日本和歌山医科大学接受了耳后筋膜移植的额下垂患者。随访不足(<6个月)的患者被排除在研究之外。符合条件的患者被分为以下三个评估组之一:“良好”(改善睑裂高度,无侧向,边缘反射距离-右侧和左侧之间的1个间隙<0.5mm),“正常”(侧向改善睑裂高度),或“差”(睑裂高度改善不良)。25例患者中的35只眼接受了耳后筋膜移植治疗。术后平均随访27个月。8例患者被分类为良好(32%),15个公平(60%),差两个(8%)。2例患者(8%)术后出现了眩眼。没有病人有睫毛倒置,髌骨畸形,或上睑下垂复发。沿发际线边缘的疤痕不显眼,也没有肥厚性疤痕。本文首次描述了使用耳后筋膜移植技术对眼睑进行功能重建。这种移植技术可能是额骨悬吊手术的有用替代方法,因为它可以轻松获取且不会留下明显的疤痕。
    Frontalis suspension surgery is commonly used for the repair of congenital ptosis and involutional blepharoptosis with poor levator function. Grafts for this procedure have been developed using a variety of different materials, each with advantages and disadvantages. The retroauricular fascia graft might be beneficial in this surgery. This article reports the surgical results of blepharoptosis, who were treated with the retroauricular fascia, which is a new autologous graft for the frontalis suspension technique. This case series study targeted patients with ptosis who underwent frontalis suspension surgery with the retroauricular fascia graft at Wakayama Medical University in Japan between May 2016 and May 2023. Patients with insufficient follow-up (<6 months) were excluded from the study. Eligible patients were categorized into one of the following three assessment groups: \"good\" (improvement of palpebral fissure height without laterality, Margin reflex distance-1 gap between right and left side <0.5 mm), \"fair\" (improvement of palpebral fissure height with laterality), or \"poor\" (poor improvement of palpebral fissure height). Thirty-five eyes in 25 patients were treated with the retroauricular fascia graft. The mean postoperative follow-up was 27 months. Eight patients were classified as good (32%), 15 as fair (60%), and two as poor (8%). Two patients (8%) had postoperative lagophthalmos. No patients had eyelash inversion, tarsal deformity, or recurrence of ptosis. Scars along the edge of the hairline were inconspicuous and there were no hypertrophic scars. Functional reconstruction of the eyelids using the retroauricular fascia graft technique is described here for the first time. This grafting technique may be a useful alternative for frontalis suspension surgery because it can be harvested with easy access and without leaving conspicuous scars.
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  • 文章类型: Journal Article
    背景:进行了多种手术方法来矫正上睑下垂。然而,上睑下垂的复发在临床实践中并不少见。颞筋膜复合片(TFC片)是矫正重度上睑下垂的理想自体材料。在本回顾研究中,我们介绍了用TFC片悬吊技术矫正重度复发性上睑下垂的经验,并描述后续结果,以说明其有效性和实用性。
    方法:本研究共纳入16例(23只眼)重度复发性上睑下垂患者。所有患者均在同一治疗组进行初次手术后>12个月进行颞筋膜复合片悬吊手术。边缘到反射距离1(MRD1),修正效应,和眼睑对称性用于评估临床结局。
    结果:19个眼睑(82.6%)显示出良好的矫正效果,5个眼睑(21.7%)显示出公平的矫正结果。术前MRD1(pre-MRD1)平均值为-0.17±0.97,术后MRD1(post-MRD1)平均值为4.01±1.24。前MRD1和后MRD1之间存在统计学上的显著差异(p<0.0001)。在13例患者中观察到良好的对称性(81.3%)。所有入组患者均对手术效果满意。
    结论:颞筋膜复合片悬吊术是矫正复发性上睑下垂的有效且安全的方法。
    Multiple surgical methods were performed to correct the blepharoptosis. However, the recurrence of blepharoptosis is not uncommon in clinical practice. The Temporal-Fasciae-Complex Sheet (TFC sheet) was an ideal autologous material in correcting the severe blepharoptosis. In the present retrospected study, we introduced our experience in the correction of severe recurrent blepharoptosis with the technique of TFC sheet suspension, and describe the follow-up results to illustrate its effectiveness and practicality.
    A total of 16 patients (23 eyes) with severe recurrent blepharoptosis were enrolled in this study. All the patients were performed with temporal-fasciae-complex sheet suspension surgeries for revision> 12 months after the primary surgeries by the same treatment group. The margin-to-reflex distance 1 (MRD1), correction effect, and eyelid symmetry were used to evaluate clinical outcomes.
    19 eyelids (82.6%) showed good correction results, and 5 eyelids (21.7%) showed fair correction results. The average value of preoperative-MRD1(pre-MRD1) was - 0.17 ± 0.97, and the average value of postoperative-MRD1(post-MRD1) was 4.01 ± 1.24. There was a statistically significant difference between pre-MRD1 and post-MRD1 (p < 0.0001). Good symmetry was observed in 13 patients (81.3%). All patients enrolled were satisfied with the surgical results.
    The Temporal-Fasciae-Complex Sheet Suspension is an effective and safe method for correcting the recurrent blepharoptosis.
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  • 文章类型: Journal Article
    目的:比较不同手术技术对先天性上睑下垂修复的手术和屈光效果。
    方法:这项纵向队列研究回顾了101例先天性上睑下垂修复患者的医疗记录,从2006年到2022年在一个单一的中心。对人口统计背景进行了分析,合并症,术前和术后眼部检查和屈光检查,并发症,重新操作,和成功率。
    结果:按照排除标准,我们保留了80例(103只眼)接受额肌悬吊术(FMS)(55只眼)或提肌手术(LM)(48只眼)的患者.FMS组的患者年龄较小(平均年龄3.1岁与6.0年,p<0.001),并且术前眼部评估较差,包括视轴受累的患病率,下巴向上的头部位置,上睑下垂的严重程度,提上肌功能(LF)(p<0.001)。两组均有25%的再手术率,然而,虽然在LM组中,由于纠正不足而需要重新手术,FMS组中各种指示提示再次操作。FMS组的成功率更高(87.3%vs.60.4%,p=0.002)。虽然LM组的术前散光较高(p=0.019),术后未观察到显著差异.仅在FMS组中,球形和球形等效随时间的变化显着(分别为p=0.010和p=0.004)。
    结论:在我们的队列中,与LM相比,在接受FMS的患者中观察到先天性上睑下垂修复的成功率更高,尽管再次手术率相似。在严重上睑下垂和中度LF的情况下,LM的成功率低于预期。上睑下垂修复后的散光变化在两组中均不一致。
    OBJECTIVE: Comparing the surgical and refractive outcomes of congenital ptosis repair by different surgical techniques.
    METHODS: This longitudinal cohort study reviewed medical records of 101 patients who underwent congenital ptosis repair, from 2006 to 2022 in a single center. Analysis was performed for demographic background, co-morbidities, pre-operative and post-operative ocular examinations and refraction, complications, reoperations, and success rates.
    RESULTS: Following exclusion criteria, we remained with 80 patients (103 eyes) who underwent either frontalis muscle suspension surgery (FMS) (55 eyes) or levator muscle surgery (LM) (48 eyes). Patients in the FMS group were younger (mean age of 3.1 vs. 6.0 years, p < 0.001) and had worse pre-operative ocular assessments including prevalence of visual axis involvement, chin-up head position, ptosis severity, and levator muscle function (LF) (p < 0.001). Both groups had a 25% rate of reoperation, however while in the LM group reoperation was required solely due to undercorrection, in the FMS group various indications prompted reoperation. Success rate was higher in the FMS group (87.3% vs. 60.4%, p = 0.002). While pre-operative astigmatism was higher in the LM group (p = 0.019), no significant differences were observed post-operatively. Spherical and spherical equivalent changes over time were significant only in the FMS group (p = 0.010 and p = 0.004, respectively).
    CONCLUSIONS: Within our cohort, a higher success rate of congenital ptosis repair was observed among patients who underwent FMS compared to LM, despite similar reoperation rates. In cases of severe ptosis and moderate LF, LM demonstrated a lower-than-anticipated success rate. Astigmatic changes following ptosis repair were not consistent in either group.
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  • 文章类型: Journal Article
    未经批准:确定治疗MarcusGunn眨眼综合征(MGJWS)患者的基本原理。
    UNASSIGNED:回顾性回顾38例MGJWS患者,转诊至一家高等教育机构。临床数据包括视力,眼运动性,下巴眨眼的一侧,有无上睑下垂,提升机功能,临床照片,和管理。由高级外科医生(FQL)对32例患者进行了定制手术。
    UNASSIGNED:无下垂或轻度下垂的病例采用保守治疗。在中度上睑下垂和可忽略的综合症的情况下,提肌前移(LA)是成功的,但导致了更明显的综合症。严重上睑下垂患者的提肌切除术(LR)与上睑复发率高有关。在接受单或双侧提上肌切除术(LE)和双侧额肌悬吊(FS)或单侧额肌皮瓣(FF)的所有患者中,下垂均得到了充分纠正。所有接受LE治疗的患者的颌骨眨眼均消失,但在后期有三例复发。在相关的内斜视或下斜视的情况下,同时进行斜视手术。
    UNASSIGNED:中度上眼睑可以用LA矫正,但是成功与提上肌功能无关,术后联合运动变得更加明显。在严重上睑下垂时,LR显示不可预测的结果。如果有严重的下垂和严重的联合运动,建议使用单侧或双侧LE和双侧FS;单侧FF是拒绝双侧治疗的患者的替代方案,因为美容结果通常比单侧FS后好。
    UNASSIGNED: To identify a rationale for treatment of patients with Marcus Gunn jaw winking syndrome (MGJWS).
    UNASSIGNED: Retrospective review of 38 consecutive patients with MGJWS referred to a single tertiary institution. Clinical data included visual acuity, ocular motility, side of jaw-wink, presence or absence of ptosis, levator function, clinical photographs, and management undertaken. Thirty-two patients were operated on with customized surgery by a senior surgeon (FQL).
    UNASSIGNED: Cases with no ptosis or mild ptosis were managed conservatively. Levator advancement (LA) was successful in case of moderate ptosis and negligible synkynesis but resulted in a more evident synkinesis. Levator resection (LR) in patients with severe ptosis was associated with high rate of ptosis recurrence. Ptosis was adequately corrected in all patients submitted to uni- or bilateral levator excision (LE) and bilateral frontalis suspension (FS) or unilateral frontalis flap (FF). Jaw winking resolved in all patients submitted to LE but recurred in three cases at a later stage. Strabismus surgery was performed simultaneously in case of associated esotropia or hypotropia.
    UNASSIGNED: Moderate ptosis can be corrected with LA, but success is not related to levator function and synkinesis becomes more evident postoperatively. In severe ptosis, LR showed unpredictable results. In case of severe ptosis and severe synkinesis, uni- or bilateral LE and bilateral FS are recommended; unilateral FF is an alternative in patients who refuse bilateral treatment, as the cosmetic outcome is usually better than after unilateral FS.
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  • 文章类型: Journal Article
    背景:研究单侧重度先天性上睑下垂患者在额骨悬吊术后的散光特征和手术结果。
    方法:我们纳入了湖南省儿童医院收治的53例先天性上睑下垂患者。每位患者在手术前后进行屈光检查以评估散光。我们还评估了与手术相关的效果和并发症。
    结果:术前眼球和对侧眼的散光程度分别为-1.45±0.59D和-0.66±0.51D。眼睑和同侧眼严重散光的比率为51.3%和12.8%。同伴的眼睛表现为规则散光(WR;71.8%)和违规散光(AR;20.5%)类型,无斜行散光(OA)病例。下眼显示AR(59.0%)和OA(10.2%)的频率高于其他眼。此外,前者表现出增加的散光,随后在6个月逐渐减少,在术后1年显着下降之前。术后1个月后,前闭眼的AR和OA散光例数下降至35.9%和7.7%。然而,术后1个月WR比率从30.8%增加至56.4%.Kaplan-Meier生存分析显示,6个月的成功率为81.4%,12个月的成功率为62.9%,受以下并发症的影响:缝合反应,上皮角膜病变,感染和肉芽肿,盖子滞后,和复发。
    结论:单眼先天性上睑下垂可形成严重的散光和更高的AR或OA频率,早期手术可以改善散光性弱视。
    BACKGROUND: To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery.
    METHODS: We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children\'s Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure.
    RESULTS: Degree of astigmatism in ptotic and fellow eyes was - 1.45 ± 0.59 D and - 0.66 ± 0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3 and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9 and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8 to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence.
    CONCLUSIONS: Monocular congenital ptosis could develop severe astigmatism and higher frequency of AR or OA, early surgery may ameliorate astigmatic amblyopia.
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  • 文章类型: Journal Article
    膨胀型聚四氟乙烯(e-PTFE)额骨悬吊术应用于先天性上下垂儿童的价值分析。
    随机选取我院2019年10月至2021年10月收治的先天性上睑下垂患儿80例。根据治疗方法分为观察组(n=44)采用e-PTFE额肌悬吊术治疗,对照组(n=36)采用额肌皮瓣悬吊术治疗。眼睑状况比较[睑裂高度,边缘反射距离(MRD),眼睑闭合时间],眼表状态[角膜荧光素染色(CFS)评分,泪膜破裂时间(TBUT),手术眼泪道高度(LRH),sehirmertestI(STI)],患侧的额叶肌肉力量,两组在术后1、6和12个月随访时的美容效果和并发症。
    手术后1、6和12个月,两组患者的睑裂高度和MRD差异无统计学意义(p>0.05);观察组眼睑闭合时间短于对照组(p<0.05)。手术后1、6和12个月,观察组CFS评分低于对照组(p<0.05);术后6、12个月,观察组的TBUT较长,手术眼LRH高于对照组(p<0.05);术后1、6、12个月,两组之间的STI没有显着差异(p<0.05)。手术后1、6和12个月,观察组患侧额叶肌力高于对照组(p<0.05)。手术后1、6和12个月,两组的美容效果无显著差异(p>0.05)。观察组并发症总发生率(6.82%)低于对照组(25.00%)(p<0.05)。
    e-PTFE额肌悬吊和额肌皮瓣悬吊应用于先天性上睑下垂的手术和美容效果相当,但前者的优点是术后恢复快,更好的眼表状态,额骨肌力损伤少,并发症少。
    UNASSIGNED: Analysis of the value of expanded polytetrafluoroethylene (e-PTFE) frontalis suspension applied to children with congenital ptosis.
    UNASSIGNED: Eighty clinical cases of children with congenital ptosis from October 2019 to October 2021 were randomly selected from our hospital. All children were divided into the observation group (n = 44) treated with e-PTFE frontalis suspension and the control group (n = 36) treated with frontalis flap suspension according to the treatment procedure. Comparison of eyelid condition [palpebral fissure height, margin reflex distance (MRD), eyelid closure time], ocular surface status [corneal fluorescein staining (CFS) score, tear film breakup time (TBUT), surgical eye lacrimal river height (LRH), sehirmer test I (STI)], frontal muscle strength of affected side, cosmetic results and complications in both groups at 1, 6 and 12 months postoperative follow-up.
    UNASSIGNED: At 1, 6 and 12 months after surgery, there was no significant difference in terms of palpebral fissure height and MRD between both groups (p > 0.05); After surgery, the eyelid closure time was shorter in the observation group than in the control group (p < 0.05). At 1, 6 and 12 months after surgery, the CFS scores were lower in the observation group than in the control group (p < 0.05); At 6 and 12 months after surgery, the TBUT was longer and the surgical eye LRH was higher in the observation group than in the control group (p < 0.05); At 1, 6, and 12 months after surgery, there was no significant difference in STI between both groups (p < 0.05). At 1, 6 and 12 months after surgery, the frontal muscle strength of affected side was higher in the observation group than in the control group (p < 0.05). At 1, 6, and 12 months after surgery, there was no significant difference in cosmetic results between both groups (p > 0.05). The overall complication rate in the observation group (6.82%) was lower than that in the control group (25.00%) (p < 0.05).
    UNASSIGNED: The surgical and cosmetic results of e-PTFE frontalis suspension and frontalis flap suspension applied to congenital ptosis are comparable, but the former has the advantage of faster postoperative recovery, better ocular surface status, less frontali muscle strength damage and fewer complications.
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  • 文章类型: Journal Article
    额骨悬吊术(FS)是先天性上睑下垂的首选治疗方法。我们报告了儿童使用双三角形硅胶吊索的FS手术结果。
    一项回顾性队列研究,对12年(2009-2020年)的所有小儿单纯性肌源性先天性下垂患儿进行FS修复。每个硅胶吊带由简单的结固定。使用ImageJ软件从临床照片确定术前和术后边缘反射距离(MRD1)测量值。主要结局指标是改善眼睑高度,眼睑不对称,再手术率和时机。
    纳入了139名患者(174只眼),35(25%)进行双侧手术。平均(±SD)年龄为1.4±1.9岁。平均随访时间为32±20.5个月。16例患者(11%)有既往上睑下垂修复手术史。平均MRD1平均改善1.5mm。未进行第二次手术的患者组中的最终MRD1平均为2.1mm。在所有单侧病例中,双眼之间的MR1差异从术前的2.5mm改善到最后一次就诊时的1.2mm(p<0.001)。在123例没有上睑下垂手术史的病例中,对37例(30%)患者进行了重复上睑下垂修复,初始手术后34.9±19.9个月。总的来说,47例患者(34%)进行了重复修复.
    双三角硅胶额悬吊术在三分之二的小儿单纯性肌源性先天性上睑下垂患者中具有良好的预后。失败的案例可以通过第二次修复来解决,使用自体筋膜或第二个硅胶吊带。
    Frontalis suspension (FS) is the treatment of choice in congenital ptosis with poor levator function. We report the surgical outcome of FS using a double triangle configuration of silicone slings in children.
    A retrospective cohort study of all paediatric patients with simple myogenic congenital ptosis repaired with FS over a 12-year period (2009-2020). Each silicone sling was secured by simple knots. Pre- and post-operative margin reflex distance (MRD1 ) measurements were determined from clinical photographs using ImageJ Software. Main outcome measures were improvement in eyelid height, eyelid asymmetry, reoperation rate and timing.
    One hundred and thirty nine patients (174 eyes) were included, with 35 (25%) having bilateral surgery. Mean (±SD) age was 1.4 ± 1.9 years. Mean follow up time was 32 ± 20.5 months. Sixteen patients (11%) had a history of previous ptosis repair surgery. Mean MRD1 improved by an average of 1.5 mm. The final MRD1 in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD1 difference between both eyes in all unilateral cases improved from 2.5 mm preoperatively to 1.2 mm at final visit (p < 0.001). In the 123 cases without a history of previous ptosis surgery, repeat ptosis repair was performed in 37 (30%) patients, 34.9 ± 19.9 months after the initial procedure. Overall, repeat repair was performed in 47 patients (34%).
    Double triangle silicone sling frontalis suspension has a favourable outcome in two-thirds of paediatric patients with simple myogenic congenital ptosis. Failed cases can be addressed with a second repair, using either autogenous fascia lata or a second silicone sling.
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