| Purpose:Congenital ptosis is caused by dysfunction of the levator palpebral muscle and Müller muscle.When congenital ptosis occurs,the upper eyelid is difficult or unable to rise and one or both eyelids are at the position lower than normal.Ptosis can affect the patient’s apperance and vision and,in some severe cases,their mental health and daily life.Timely and effective treatment of ptosis is thus necessary.Ways of surgical correction of congenital ptosis include levator muscle resection and frontalis suspension procedure.Levator muscle resection is adopted when the levator function is not less than 4 mm.Otherwise,frontalis suspension procedure is undertaken.However,as the frontal muscles and levator palpebral muscles move in different directions,augmenting the patient’s lid elevation through the frontal muscle might lead to undesirable outcomes due to anatomical abnormality.The purpose of this paper was to make levator muscle resection simpler and more applicable by keeping the Müller muscle intact during this procedure.Methods:The auyhor performed a prospective reaserch of 40 congenital ptosis patients（57 eyelids）from 6-23 years of age from October 2018 to January 2020 in the Department of Ophthalmology of the Second Hospital of Hebei Medical University.The muscle strength of patients selected ranged from 3 to 7mm.All the patients were divided into two groups-the experimental group and the control group.In the experimental group,there were 20 patients（30 eyelids）with an average age of 12.70（±5.20）,13 of them were males and 7 females,and 16 moderate cases and 4 severe ones.In the control group,there were 20 patients（27 eyelids）with an average age of12.35（±5.20）,10 of them males and 10 females,and 17 moderate cases and 3sever ones.The age,gender,and severity of ptosis of the two groups were not statistically significant after analysis（P>0.05）,and the study was feasible.The control group used the traditional method of levator muscle resection,and the experimental group used the improved one mentioned above.To acquire results needed,following records were collected 1 week,1 month,6 months,and 1 year respectively after the operation:（1）operation times;（2）blood loss during operation;（3）the effectiveness rate of correction:observed 1 month,3months,6 months,and 12 months respectively after the operation.Ptosis correction degree evaluation criteria(Correction:the upper eyelid margin covers the cornea≤2mm;overcorrection:the upper eyelid margin covers the upper edge of the cornea by less than 1mm or higher;under-correction:the upper eyelid margin covers the cornea by>2mm[1]).（4）marginal reflex distance（MRD）observed before the operation,1 month,3 months,6 months,and 12 months respectively after the operation.（5）insufficiency of eyelid closure observed 1 month,3 months,6 months,and 12 months respectively after the operation.（6）conjunctival prolapse occurring 1 day and 1 week after the operation.（7）exposure keratitis diagnosed 1 week,1 month,3 months,6months,and 12 months after the operation.Results:1.Operation timestimes in the experimental group averaged 28.6±5.44 minutes,and those in the control group 36.05±4.90 minutes（P<0.05,significant）.2.Intraoperative blood lossthe loss in the experimental group was 5.4±1.11ml,and the loss in the control group was 6.87±0.91ml（P<0.05,significant）.3.The effectiveness rate of correction:（1）one months after the operation:96.7%（29/30）in the experimental group and 77.8%（21/27）in the control group（P<0.05,significant）;（2）three months after the operation:93.3%（28/30）in the experimental group and 74.1%（20/27）in the control group（P<0.05,significant）;（3）six months after the operation:90.0%（27/30）in the experimental group and 70.4%（19/27）in the control group（P<0.05,significant）;（4）twelve months after the operation:90.0%（27/30）in the experimental group and 70.4%（19/27）in the control group（P<0.05,significant）.4.MRD（1）before the operation,the average MRD of the control group was1.01±1.14mm,and the average MRD of the experimental group MRD was1.18±1.09mm（P>0.05,non-significant）;（2）one month after the operation,the average MRD of the control group was 3.11±0.502mm,and the average MRD of the experimental group was3.52±0.36mm（P<0.05,significant）;（3）three months after the operation,the average MRD of the control group was 3.86±0.18mm,and the average of the experimental group was3.97±0.18mm（P<0.05,significant）;（4）six months after the operation,the average MRD of the control group was 2.92±0.40mm,and the average of the experimental group was3.42±0.37mm（P<0.05,significant）;（5）twelve months after the operation,the average MRD of the control group was 2.98±0.47mm,and the average of the experimental group was3.43±0.38mm（P<0.05,significant）.5.Incomplete eyelid closure（1）the average amount of incomplete eyelid closure 1 month after the operation in the control group was 3.39±0.32mm,and the amount in the experimental group was 3.06±0.34mm（P<0.05,significant）;（2）the average amount of incomplete eyelid closure 3 months after the operation was 1.81±0.46mm in the control group and 1.48±0.52mm in the experimental group（P<0.05,significant）;（3）the average amount of incomplete eyelid closure 6 months after the operation in the control group was 0.70±0.26mm,and the amount in the experimental group was 0.33±0.27mm（P<0.05,significant）;（4）the average amount of incomplete eyelid closure 12 months after the operation in the control group was 0.33±0.22mm,and the amount in the experimental group was 0.105±0.185mm（P<0.05,significant）.6.Exposure keratitis（1）one week after the operation,there were 5 exposure keratitis cases（7eyelids）in the control group,and 1 case（2 eyelids）in the experimental group.The incidence of exposure keratitis was 25.9%（7/27）in the control group and 6.7%（2/30）in the experimental group（P<0.05,significant）;（2）one month after the operation,there were 3 cases（4 eyelids）of exposure keratitis in the control group,and no exposure keratitis in the experimental group.The incidence of exposure keratitis was14.8%（4/27）of the control group and 0%in the experimental group（P<0.05,significant）;（3）no exposure keratitis was diagnosed in the follow-up research 3months,6 months,and 12 months after the operation.7.Conjunctival prolapse（1）one day after the operation,4 patients（6 eyelids）in the control group,and 1 patient（1 eyelid）in the experimental group developed conjunctival prolapse on the first day after surgery.The incidence of conjunctival prolapse was 22.2%（6/27）in the control group and 3.3%（1/30）in the experimental group（P<0.05,significant）.（2）one week after operation,symptoms of conjunctival prolapse found in the patients mentioned above disappeared after prompt treatment was given,and no recurrence was found;no patient had conjunctival prolapse 1month,3 months,6 months after the operation.Conclusions:1.The improved levator muscle resection shortens the operation time,reduces the bleeding during the operation,has a light postoperative response and requires less recovery time.2.The improved levator muscle resection completely preserves the Müller muscle,making this procedure simpler and more applicable.3.The improved levator muscle resection raises the success rate of the operation.4.The improved levator muscle resection leads to fewer postoperative complications. |
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