TRANSEYELID FIXATION OF PROLAPSED CONJUNCTIVA FOLLOWING LEVATOR MUSCLE RESECTION FOR CONGENITAL PTOSIS: A CASE REPORT

先天性眼瞼下垂上舉肌切除術後結膜脫垂之手術治療

蔡佳穎(Chia-Ying Tsai) ； 陳右昇(Yo-Shen Chen) ； 蔡紫薰(Tzu-Hsun Tsai) ； 楊中美(Chung-May Yang)

《中華民國眼科醫學會雜誌》 55卷 (2016/12) Pp. 50-53

https://doi.org/10.30048/ACTASOS.201612_55.0008

摘要

Purpose: To report a case with surgical treated conjunctival prolapse following large levator muscle resection. Method: Case report. Result: Here we report a case involving a boy aged 2 years and 10 months who developed conjunctival prolapse 1 week after moderate levator muscle resection of 17 mm for unilateral congenital ptosis. Surgical intervention involving the resection of some prolapsed conjunctiva and anchorage using 8-0 vicryl through the fornix to the skin was successful, with no reccurrence over the 2-year follow-up. Conclusion: Unilateral congenital ptosis may hinder visual development and cause amblyopia in children. Surgical correction is indicated when the visual axis is obscured. Conjunctival prolapse is a rare complication, which can be prevented by limited resection of the levator aponeurosis anterior to the Whitnall’s ligament, meticulous dissection between the aponeurosis and conjunctiva, and application of a transeyelid fixation suture during surgery for ptosis.

關鍵字

conjunctival prolapse ； levator muscle resection ； congenital ptosis

並列摘要

目的：報告一位先天性眼瞼下垂接受上舉肌切除手術，術後產生結膜脫垂之併發症，以手術成功治療之案例。方法：案例報告 結果：一位兩歲十個月大之單側先天性眼瞼下垂病人，自出生就有左眼眼瞼下垂之問題。雙眼檢查顯示，眼瞼邊緣距瞳孔反光距離(上/下)，右眼為3/5mm，左眼為0-1/5mm；上舉肌功能，右眼為10mm，左眼為4mm。病人在接受左眼上舉肌切除手術17mm後，出現左眼結膜脫垂之症狀。兩周後病人 接受左眼結膜復位手術，利用8-0 Vicryl線將脫垂的結膜固定，並切除部分的結膜組織。病人術後恢復情形良好，且追蹤後無復發情形。結論：單側先天性眼瞼下垂為造成病人弱視的原因之一，上舉肌切除為治療先天性眼瞼下垂之手術方法。大範圍之上舉肌切除被應用於治療較嚴重之先天性眼瞼下垂病人(上舉肌功能小於7mm)。結膜脫垂為上舉肌切除之罕見併發症，發生原因可能為術中傷害懸韌帶，或術後發炎導致結膜水腫所致。預防其發生的方法包括：避免過大範圍上舉肌的切除傷害到懸韌帶、術中小心剝離結膜及結締組織，以及術中合併經眼瞼固定結膜縫線。