Catastrophic Result from Blepharoptosis Overcorrection-Case Report

眼瞼下垂過度矯正的災難性結果－病例報告

林仲樞(Chung-Shu Lin) ； 歐聖運(Shuan-Yuan Ou)

《中華民國整形外科醫學會雜誌》 10卷2期 (2001/06) Pp. 145-150

https://doi.org/10.7096/JPSA.200106.0011

摘要

眼瞼下垂的矯正手術，在術後併發症中，除了矯正不足是最常遇見的問題外，過度矯正亦是一重要課題，特別於再次手術。一般眼瞼下垂術後，常會有些許程度的暫時性眼瞼過高、眼瞼遲緩、和閉合不全，在保守療法下，4~6週內大都會回復；如果無法忍受，可以早期移除縫線，或之後接受眼瞼倒退手術，而當中很重要的是角膜的照顧。如果忽視此一問題或處理不當，可能導致災難性的結果！我們報告一先天性眼瞼下垂之病例，幼年時接受眼瞼懸吊手術，因矯正不足而於數年後接受二次手術，術後出現過度矯正，且閉合不全；而術中疑有角膜傷害，並且之後眼瞼無法覆蓋並保護角膜，在未有適當處理下，導至後來的失明。在眼科醫師歷經三次角膜移植失敗後，轉診回整形科醫師，先解決眼瞼覆蓋、閉合的問題。我們進行眼瞼倒退手術，將眼瞼放鬆，並加上軟骨和全層皮膚移植；術後復原良好，有適當的眼球覆蓋及保護，可進行下一步角膜手術。本篇報告此一結果，並回顧眼瞼下垂過度矯正的處理及文獻。

並列摘要

Although undercorrection of blepharoptosis is more common, overcorrection can be a serious problem, especially after a second operation. Mild overcorrection with slight lid lag or even lagophthalmos is often acceptable immediately after surgery, as it may resolve spontaneously within 4-6 weeks. However, suture release in the early period or lid recession surgery later may be necessary for especially bothersome overcorrection. Regardless of the treatment plan, meticulous care must be given to prevent keratitis until adequate lid closure is achieved. Failure to do so may be catastrophic. We report a young woman with congenital blepharoptosis who had undergone frontal muscle sling surgery in childhood resulting in undercorrection. A second operation several years later resulted in over- correction. She developed corneal problems, although it is unclear whether this was all due to loss of adequate lid coverage or if there had also been some corneal injury during surgery. In any event, the corneal problem worsened to the point that the patient lost her vision in that eye. Corneal transplantation was undertaken three times and failed each time. Therefore, she was transferred to our department for a procedure to yield competent lid closure. We performed lid recession surgery with lid release, cartilage graft and FTSG. The post-operative result was good, with adequate corneal protection. We present this case and review the literature on management of overcorrection of blepharoptosis.

並列關鍵字

blepharoptosis ； overcorrection ； blindness ； lid retraction ； lagophthalmos ； lid recession surgery