改良额肌瓣悬吊术治疗13例中重度下颌瞬目综合征
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摘要
目的探讨改良额肌瓣悬吊术治疗下颌瞬目综合征的临床疗效。方法回顾就诊于上海交通大学医学院附属第九人民医院眼科的下颌瞬目综合征患者,收集经改良额肌瓣悬吊术治疗的13例(13只眼)患者的病史资料,13例患者术前经上睑下垂及颌动瞬目现象严重程度进行分级,均表现为中重度,经同一术者手术治疗后对13例患者进行治疗效果及并发症观察。结果本组患者疗效良好,术后随访时间为(26.31±18.67)个月(范围:8-63个月);双眼睑缘高度基本一致,睑缘弧度自然,无畸形;颌动瞬目现象基本解除[术前(4.46±1.45)mm至术后(0.92±0.76) mm],睑缘角膜映光1(MRD1)由术前(-0.31±1.11)mm提高至(4.23±1.01)mm,最佳矫正视力(BCVA)由0.43±0.22提高至0.74±0.28。结论该术式较好地矫正了颌动瞬目现象,同时可获得稳定的眼睑高度;患者术后视力获得显著提升;无严重并发症,是用于矫正中重度下颌瞬目综合征安全有效的手术方式。
Objective To investigate the clinical effect of modified frontalis muscle flap suspension surgery on Marcus Gunn jaw winking syndrome(MGJWS). Methods Data of 13 patients(13 eyes) with MGJWS who underwent modified frontal muscle flap suspension surgery in the Department of Ophthalmology of the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine were reviewed. All patients presented with moderate to severe MGJWS and blephroptosis before the surgery. Treatment effect and surgical complications were assessed for all patients after the surgery which was performed by the same surgeon. Results Good clinical effect was observed for all patients. Patients were followed up for 26.31 ± 18.67 months(range: 8～63 months). The bilateral eyelids palpebral fissure were basically the same, the curvature of eyelid was natural and without deformity. The MGJWS improved from 4.46±1.45 mm before the surgery to 0.92±0.76 mm after the surgery. The MRD1 improved from-0.31±1.11 mm before the surgery to 4.23±1.01 mm after the surgery. Similarly, the best corrected visual acuity significantly improved from 0.43±0.22 to 0.74±0.28. Conclusions The modified surgical method can effectively correct the MGJWS, achieve stable eyelid height, significantly improve post-surgical visual acuity and without severe complications, thus is an effective and safe treatment option for patients with moderate to severe MGJWS.
Objective To investigate the clinical effect of modified frontalis muscle flap suspension surgery on Marcus Gunn jaw winking syndrome(MGJWS). Methods Data of 13 patients(13 eyes) with MGJWS who underwent modified frontal muscle flap suspension surgery in the Department of Ophthalmology of the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine were reviewed. All patients presented with moderate to severe MGJWS and blephroptosis before the surgery. Treatment effect and surgical complications were assessed for all patients after the surgery which was performed by the same surgeon. Results Good clinical effect was observed for all patients. Patients were followed up for 26.31 ± 18.67 months(range: 8～63 months). The bilateral eyelids palpebral fissure were basically the same, the curvature of eyelid was natural and without deformity. The MGJWS improved from 4.46±1.45 mm before the surgery to 0.92±0.76 mm after the surgery. The MRD1 improved from-0.31±1.11 mm before the surgery to 4.23±1.01 mm after the surgery. Similarly, the best corrected visual acuity significantly improved from 0.43±0.22 to 0.74±0.28. Conclusions The modified surgical method can effectively correct the MGJWS, achieve stable eyelid height, significantly improve post-surgical visual acuity and without severe complications, thus is an effective and safe treatment option for patients with moderate to severe MGJWS.
引文
[1] Pearce FC,McNab AA,Hardy TG.Marcus Gunn jaw-winking syndrome:A comprehensive review and report of four novelcCases[J].Ophthalmic Plast Reconstr Surg,2017,33(5):325-328.
[2] 周炼红,张俊涛,陈樱,等.中重度Marcus-Gunn综合征患者的手术治疗[J].眼科新进展,2012,32(2):172-174.
[3] Bajaj M S,Angmo D,Pushker N,et al.Modified technique of levator plication for the correction of Marcus Gunn jaw-winking ptosis:a case series[J].Int Ophthalmol,2015,35(4):587-591.
[4] Ho Yeen-Fey,Wu Shu-Ya,Tsai Yueh-Ju.Factors associated with surgical outcomes in congenital ptosis:a 10-year study of 319 cases.[J] .Am J Ophthalmol,2017,175:173-182.
[5] Bowyer JD,Sullivan TJ.Management of Marcus Gunn jaw winking synkinesis[J].Ophthalmic Plast Reconstr Surg,2004,20(2):92-98.
[6] Zhang L,Pan Y,Ding J,et al.Surgical correction of myogenic ptosis using a modified levator resection technique[J].Can J Ophthalmol,2015,50(6):471-475.
[7] G?ncü T,akmak S,Akal A,et al.Improvement in levator function after anterior levator resection for the treatment of congenital ptosis[J].Ophthalmic Plast Reconstr Surg,2015,31(3):197-201.
[8] Lee JH,Nam SM,Kim YB.Blepharoptosis correction:levator aponeurosis-Müller muscle complex advancement with three partial incisions[J].Plast Reconstr Surg,2015,135(2):388-395.
[9] Tsai CC,Lin TM,Lai CS,et al.Use of the orbicularis oculi muscle flap for severe Marcus Gunn ptosis[J].Ann Plast Surg,2002,48(4):431-434.
[10] 甘晓玲.中华眼科学会全国儿童弱视斜视防治学组.弱视的定义、 分类及疗效评价标准[J].中国斜视与小儿眼科杂志,1996,4(3):97- 98.
[11] Demirci H,Frueh BR,Nelson CC.Marcus Gunn jaw-winking synkinesis:clinical features and management[J].Ophthalmology,2010,117(7):1447-1452.
[12] Merriam WW,Ellis FD Helveston EM.Congenital blepharoptosis,anisometropia,and amblyopia[J].Am J Ophthalmol,1980,89(3):401-407.
[13] 汪芳润.弱视诊断标准(讨论稿)[J].中国斜视与小儿眼科杂志,2010,18(3):97-98.
[14] Conte A,Brancati F,Garaci F,et al.Kinematic and diffusion tensor imaging definition of familial Marcus Gunn jaw-winking synkinesis[J].PLoS One,2012,7(12):e51749.
[15] Xiang N,Hu WK,Li B,et al.Management of morderate-to-severe Marcus-Gunn syndrome by anastomosis of levator and frontal muscles[J].Int J Ophthalmol,2010,3(4):342-342.
[16] Park DH,Choi WS,Yoon SH.Treatment of the jaw-winking syndrome[J].Ann Plast Surg,2008,60(4):404-409.
[17] Khwarg SI,Tarbet KJ,Dortzbach RK,et al.Management of moderate-to-severe Marcus-Gunn jaw-winking ptosis[J].Ophthalmology,1999,106(6):1191-1196.
[18] Ibrahim HA.Use of the levator muscle as a frontalis sling[J].Ophthalmic Plast Reconstr Surg,2007,23(5):376-380.
[2] 周炼红,张俊涛,陈樱,等.中重度Marcus-Gunn综合征患者的手术治疗[J].眼科新进展,2012,32(2):172-174.
[3] Bajaj M S,Angmo D,Pushker N,et al.Modified technique of levator plication for the correction of Marcus Gunn jaw-winking ptosis:a case series[J].Int Ophthalmol,2015,35(4):587-591.
[4] Ho Yeen-Fey,Wu Shu-Ya,Tsai Yueh-Ju.Factors associated with surgical outcomes in congenital ptosis:a 10-year study of 319 cases.[J] .Am J Ophthalmol,2017,175:173-182.
[5] Bowyer JD,Sullivan TJ.Management of Marcus Gunn jaw winking synkinesis[J].Ophthalmic Plast Reconstr Surg,2004,20(2):92-98.
[6] Zhang L,Pan Y,Ding J,et al.Surgical correction of myogenic ptosis using a modified levator resection technique[J].Can J Ophthalmol,2015,50(6):471-475.
[7] G?ncü T,akmak S,Akal A,et al.Improvement in levator function after anterior levator resection for the treatment of congenital ptosis[J].Ophthalmic Plast Reconstr Surg,2015,31(3):197-201.
[8] Lee JH,Nam SM,Kim YB.Blepharoptosis correction:levator aponeurosis-Müller muscle complex advancement with three partial incisions[J].Plast Reconstr Surg,2015,135(2):388-395.
[9] Tsai CC,Lin TM,Lai CS,et al.Use of the orbicularis oculi muscle flap for severe Marcus Gunn ptosis[J].Ann Plast Surg,2002,48(4):431-434.
[10] 甘晓玲.中华眼科学会全国儿童弱视斜视防治学组.弱视的定义、 分类及疗效评价标准[J].中国斜视与小儿眼科杂志,1996,4(3):97- 98.
[11] Demirci H,Frueh BR,Nelson CC.Marcus Gunn jaw-winking synkinesis:clinical features and management[J].Ophthalmology,2010,117(7):1447-1452.
[12] Merriam WW,Ellis FD Helveston EM.Congenital blepharoptosis,anisometropia,and amblyopia[J].Am J Ophthalmol,1980,89(3):401-407.
[13] 汪芳润.弱视诊断标准(讨论稿)[J].中国斜视与小儿眼科杂志,2010,18(3):97-98.
[14] Conte A,Brancati F,Garaci F,et al.Kinematic and diffusion tensor imaging definition of familial Marcus Gunn jaw-winking synkinesis[J].PLoS One,2012,7(12):e51749.
[15] Xiang N,Hu WK,Li B,et al.Management of morderate-to-severe Marcus-Gunn syndrome by anastomosis of levator and frontal muscles[J].Int J Ophthalmol,2010,3(4):342-342.
[16] Park DH,Choi WS,Yoon SH.Treatment of the jaw-winking syndrome[J].Ann Plast Surg,2008,60(4):404-409.
[17] Khwarg SI,Tarbet KJ,Dortzbach RK,et al.Management of moderate-to-severe Marcus-Gunn jaw-winking ptosis[J].Ophthalmology,1999,106(6):1191-1196.
[18] Ibrahim HA.Use of the levator muscle as a frontalis sling[J].Ophthalmic Plast Reconstr Surg,2007,23(5):376-380.