使用Silicone Rod矯正眼瞼下垂

Silicone Rod for Correcting Blepharoptosis

洪聖德(Sheng-De Hung) ； 陳喬鴻(Chiao-Hong Chen)

《中華民國眼科醫學會雜誌》 45卷3期 (2006/09) Pp. 178-184

https://doi.org/10.30048/ACTASOS.200609.0006

摘要

目的：評估使用silicone rod frontalis slings來矯正眼瞼下垂病人的結果。
方法：我們追蹤自2002-2004年間使用silicone rod frontalis slings的病患，23位病人，27個眼睛，其中兩位是外傷導致單側third nerve palsy，一位是單側Marcus Gunn jaw-winking syndrome，一位是單側眼瞼下垂已接受三次傳統矯正手術，一位是單側眼瞼下垂已接受一次傳統矯正手術，一位單側先天性眼瞼下垂的小朋友，一位雙側先天性眼瞼下垂的小朋友，其他19個眼睛均是先天性眼瞼下垂的成人(table 1)。
結果：術後平均追蹤11.8個月（4-24個月），我們根據病人上眼瞼的高度及兩側的對稱性來評估手術結果的好壞，術後達到預期標準的眼睛有27顆，MRD提高範圍(3mm-5mm)，平均提高MRD約3.7mm(table 1)，沒有復發的病例，其中外傷性third nerve palsy及復發性眼瞼下垂已接受三次傳統矯正手術者，兩側的對稱性較差，主要是避免術後exposure keratopathy，但均可達病患的要求；目前有一位單側先天性眼瞼下垂的3歲病患於術後追蹤數月，突然出現傷口感染裂開，導致silicone rod暴露(3.7%)，經住院清創及抗生素治療後，目前狀況穩定；有2個眼睛(7%)於術後出現mild exposure keratopathy，而這兩個眼睛在術前評估即已發現其Bell's phenomenon是不良的，經使用藥膏及藥水後均能恢復正常。
結論：silicone rod frontalis slings是用來矯正眼瞼下垂病人很有效的方法，而且因為這材質的彈性及方便調整的特性，對於嚴重眼瞼下垂而且Bell's phenomenon不良的病人，其手術效果及術後減少exposure keratopathy的嚴重程度，均比傳統使用之材質好。

並列摘要

Purpose: To evaluate the primary result of silicone rod frontalis sling for correcting blepharoptosis.
Methods: Silicone rod frontalis sling had been performed in blepharoptosis (23 cases, 27 eyes) from January 2002 to January 2004 at the Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center. We retrospectively studied the primary result of all patients.
Result: With a mean follow-up of 11.8 months, a good final result was achieved in all eyes, with no recurrent ptosis cases. The causes of blepharoptosis in the study included congenital ptosis adults and children, third-nerve palsy, Marcus Gunn jaw-winking syndrome, and recurrent ptosis (table 1). Mild exposure keratopathy occurred postoperatively in 2(7%) of 27 eyes, both in patients with inadequate or absent Bell's phenomenon prior to surgery. Wound infection with extrusion of silicone rod was found in one eye (3.7%) of a child with congenital ptosis and the condition was made stable under debridement and with the use of antibiotics. Uneven crest was found in a patient who had already undergone three previous surgeries for recurrent ptosis and in two traumatic third nerve palsy cases.
Conclusion: Several materials are useful in the frontalis slings for correction of ptosis. The silicone rod is an effective material for use in frontalis suspension in treating severe ptosis. Elasticity and ease of adjustment are favorable characteristics of using a silicone rod in frontalis slings procedure to correct severe ptosis with poor Bell's phenomenon.

並列關鍵字

silicone rod frontalis slings ； exposure keratopathy ； Bell's phenomenon