Surgical Options for Blepharoptosis in Patients with Ocular Myasthenia Gravis

眼肌型重肌症無力病人之眼瞼下垂手術治療

賴昕隄(Hsin-Ti Lai) ； 林怡雯(I-Wen Lin) ； 蘇婉茹(Wan-Ju Su) ； 郭耀仁(Yur-Ren Kuo) ； 賴春生(Chung-Sheng Lai)

《臺灣整形外科醫學會雜誌》 27卷2期 (2018/06) Pp. 93-101

摘要

Background: Ocular myasthenia gravis (OMG) is a postsynaptic neuromuscular autoimmune disorder with clinical manifestations of ptosis, diplopia, and extraocular eye muscle and orbicularis oculi weakness. Medical treatment remains the first line therapy. However, some patients are refractory to medical treatment or have serious side effects from medication. In these patients, surgical correction of blepharoptosis can be an option to improve quality of life. Aim and Objectives: Currently, there is no clear guideline to treat refractory myasthenic blepharoptosis. Different surgical options, including frontalis suspension with autogenous or exogenous materials and levator advancement, have been reported in literature. This study aims to introduce our clinical experiences in surgical options and outcomes for refractory myasthenic blepharoptosis. Materials and Methods: A retrospective study of all patients who underwent surgical correction because of refractory ocular myasthenic blepharoptosis during the past 5 years was reviewed in our institution. Patients' demographics, photographs, clinical history of OMG, perioperative changes of the margin reflex distance 1 (MRD1), levator function (LF), and quality of life (QOL) score were recorded. Results: Fifteen patients with twenty-five eyelids were enrolled in our series. Three patients were male, and others were female. The mean age at operation was 57.2 years, ranging from 42 to 71 years. Average LF was 12.36 mm, ranging from 3 to 18 mm. Preoperative MRD1 was -0.32 mm in average (range, -5 to 3 mm) and improved to 3.56 mm in average (range, 1 to 5 mm) after surgery. Of the twenty-five blepharoptosis correction procedures, frontalis sling with frontalis orbicularis oculi muscle (FOOM) flap was performed in 12 eyelids, and external levator advancement was applied in other 13 eyelids. All of our patients were satisfied after blepharoptosis correction surgeries. QOL score improved significantly after surgery from 15.9 to 4.9 averagely. Conclusion: Based on this retrospective study, patients with refractory myasthenic blepharoptosis can benefit from ptosis correction surgery with appropriate surgical criteria and surgical options.

關鍵字

ocular myasthenia gravis ； blepharoptosis ； refractory myasthenic blepharoptosis ； ptosis correction ； surgery

並列摘要

背景：眼肌型重肌症無力是一種自體免疫疾病，因自身抗體攻擊突觸後運動終版，造成眼瞼下垂、複視、眼外肌及眼輪肌無力等臨床表現。內科藥物為標準一線治療。但仍有部分病人對藥物反應不佳或對藥物有嚴重副作用，眼瞼下垂的手術治療可以改善此類病人之生活品質。目的及目標：目前並無針對眼肌型重肌症無力之眼瞼下垂治療的明確指南。過去文獻有應用自體或異體材料行前額懸吊手術以及提眼肌縮短手術等手術方法，而本篇旨在探討針對眼肌型重肌症無力之眼瞼下垂的手術治療方法及成效。材料及方法：我們回溯性的分析在本機構過去五年內因眼肌型重肌症無力症行眼瞼下垂矯正手術之所有病人，病人之基本資料、照片紀錄、臨床病史；術前術後之眼瞼下垂程度、提眼肌功能、生活品質分數變化皆詳細記錄並分析。結果：此篇報告共包含十五位病人以及二十五隻眼睛。病人之中共有三位男性，另十二位為女性。平均手術年齡為57.2歲（42歲至71歲），平均提眼肌功能為12.36毫米（3至18毫米），術前眼瞼下垂程度(MRD1)平均為 -0.32毫米（-5至3毫米）；術後眼瞼下垂程度(MRD1)平均進步至3.56毫米（1至5毫米）。所實施之二十五例眼瞼下垂矯正手術中，十二例使用復明皮瓣，另外十三例則使用提眼肌筋膜之對摺縮短術式。所有病人皆對手術感到滿意。生活品質分數從術前平均15.9分進步至4.9分。結論：根據此系列回溯性報告，若挑選適合的手術病人和相對應術式，眼肌型重肌症無力之眼瞼下垂病人可以藉此得到症狀及生活品質改善。