The Role of Hering's Law in Repair of Blepharoptosis

Hering's Law在眼瞼下垂中的角色

賴雅薇(Ya-Wei Lai) ； Austin Deng Chen ； 李書欣(Su-Shin Lee) ； 張高評(Kao-Ping Chang) ； 黃書鴻(Shu-Hung Huang) ； 吳益嘉(Yi-Chia Wu,) ； 張智豪(Chil-Hau Chang) ； 賴昕隄(Hsin-Ti Lai) ； 林幸道(Sin-Daw Lin) ； 賴春生(Chung-Sheng Lai)

《臺灣整形外科醫學會雜誌》 24卷2期 (2015/06) Pp. 138-144

摘要

背　景：Hering's law在眼瞼下垂手術的評估及術後結果有一定的重要性。在單側眼瞼下垂併Hering's law的患者，有人主張需要雙眼的眼瞼下垂矯正，才能得到較對稱的結果，然而至今沒有定論。在雙側眼瞼下垂併Hering's law的患者，有人主張需要雙眼的眼瞼下垂矯正必需同次完成，有些學者則主張分次手術。目的及目標：在此篇文章中，我們探討Hering's law的發生率及和眼瞼下垂的關係。材料及方法：回顧性統計2012年1月至12月，228位接受眼瞼下垂評估的患者中，有36位患者是Hering's law dependence。統計這些患者的病因，眼瞼肌功能，眼瞼下垂嚴重程度。進而分析24位接受手術患者的手術結果及修正率。結果：在此研究中Hering's law dependence為15.79%（36/228）。在這36位Hering's law dependence患者中，26位是單側眼瞼下垂，10位是雙側眼瞼下垂。67.39%（31/46）為正常眼瞼肌功能，41.30%（19/46）是嚴重型眼瞼下垂。在單側眼瞼下垂併Hering's law dependence的患側在手術之後，eyelid從6.05 mm進步至8.81 mm，MRD1從0.47 mm進步至3.83 mm。而對側在手術之後eyelid slit從9.32 mm掉至9.08 mm，MRD從4.05 mm掉至4.00 mm。5位患者（20.83%）因為雙側不對稱或雙眼皮消失而接受修正手術。結　論：在眼瞼肌功能正常及嚴重型眼瞼下垂的患者中，Hering's law dependence的比例較高。在單側眼瞼下垂併Hering's law的患者，我們只做單側眼瞼矯正手術，且觀察對側眼。在一個月內對側眼有自我調適至相對正常位置的傾向。在雙側眼瞼下垂併Hering's law的患者，我們主張同時雙眼矯正。因為較高的再次手術機率，在Hering's law dependence患者的評估及解釋特別需要當心。

並列摘要

Background: Development of ptosis in contralateral upper eyelids may occur after successful repair of unilateral blepharoptosis. Hering's law has significant importance in the planning and the surgical outcomes of blepharoptosis surgery. In unilateral ptosis with Hering's law dependence, bilateral ptosis repair is considered to yield better outcomes and symmetric eyelid height. However, any definite conclusions cannot be drawn as of yet. In bilateral ptosis with Hering's dependence, there is still controversy regarding the choice between simultaneous (both eyes in the same session) or sequential surgery (staged operation). Aim and Objectives: In this article, we evaluate Hering's law incidence and the impact in blepharoptosis surgery. Materials and Methods: Retrospective study of 36 patients with Hering's law dependence is evaluated in 228 blepharoptosis patients between January 2012 and December 2012. Data regarding patient demographics, etiology, levator function, and severity is studied. 24 patients underwent blepharoptosis surgery. We further analyze the operative outcomes and revision rate. Results: The incidence of Hering's law dependence is 15.79% (36/228) in our series. Among 36 patients, there are 26 patients (72.22%) with unilateral ptosis and 10 patients (27.78%) with bilateral ptosis. 67.39% (31/46) have normal levator function and 41.30% (19/46) fit the classification of severe type ptosis. In the unilateral ptosis group, mean ptotic eyelid slit improved from 6.05mm to 8.81mm, and MRD1 improved from 0.47 mm to 3.83 mm after surgery. After ptotic eyelid correction, we noted an average contralateral eyelid slit drop from 9.32mm to 9.08 mm and MRD decrease from 4.05 mm to 4 mm. Overall, 5 patients (20.83%) underwent revision surgery due to unsatisfied counter or asymmetric results. Conclusions: Hering's law dependence rate is higher in patients with normal levator function and in those with severe type blepharoptosis. In cases of unilateral ptosis with Hering's law dependence, we corrected the ptotic eyelid and noted that the contralateral eyelid usually self-adjusted and returned to relatively normal eyelid slit position within one month. In cases of bilateral ptosis with positive Hering's phenomenon, we corrected bilateral ptosis simultaneously. Due to higher revision rate, proper preoperative evaluation and explanation are particularly important in Hering's law dependence patients.

並列關鍵字

blepharoptosis ； contralateral eyelid ； Hering's law ； levator function ； revision