Superior rectus-levator synkinesis - A previously unrecognized cause of failure of ptosis surgery
Superior rectus-levator synkinesis - A previously unrecognized cause of failure of ptosis surgery
复制标题
DOI：
10.1016/s0161-6420(00)00170-6
复制
发表时间：
2000-11-01
期刊：
影响因子：
13.7
通讯作者：
Shuttleworth, GN
中科院分区：
文献类型：
--
作者：
Harrad, RA;Shuttleworth, GN
目的：描述一种以前未报道的类型的上睑下垂与异常联动之间的上级直肌和提上睑肌。设计：回顾性noncomparative cases series.Participants：7例先天性或长期单侧上睑下垂提出的区域，三级转诊，oculoplastic服务。其中6例是在2年内观察到的。方法：在进行上睑下垂手术前，对双眼的眼睑、眼球和瞳孔运动进行详细观察。主要结果测量：上睑下垂的程度及其随注视位置的变化。结果：上睑下垂消失或明显减少，使提肌功能的测量是明显正常的。通过对眼睑相对运动的仔细检查，我们发现上级直肌与提上睑肌在上视时发生了联动，其中3例仅在上睑下垂手术失败后才发现联动。一旦确认，其中2例接受了进一步手术，结果良好。结论如果将上睑提升归因于正常的提上肌功能而不是一种联动运动，那么上级直肌与提上肌的联动可能容易被忽视。我们提请注意的重要性，确定这种相对常见的条件，以计划适当的上睑下垂手术。在凝视的主要位置缺乏提上睑肌张力意味着应该进行提上睑肌的增强切除。眼科学2000;107：1975-1981（C）2000，美国眼科学会。
Purpose: To describe a previously unreported type of ptosis associated with abnormal synkinesis between the superior rectus muscle and the levator palpebrae superioris.Design: Retrospective noncomparative case series.Participants: Seven cases with congenital or longstanding unilateral ptosis presenting to a regional, tertiary referral, oculoplastic service. Six of these cases were seen within a period of 2 years.Methods: Detailed observations of eyelid, ocular, and pupil movements of both eyes were performed before the planning of ptosis surgery anterior levator resection.Main Outcome Measures: Magnitude of ptosis and its variation with the position of gaze.Results: Ptosis present in the primary position disappeared or markedly reduced with upgaze so that measurements of levator function were apparently normal. Close examination of the relative movement of the eyelids revealed evidence of superior rectus to levator synkinesis occurring during upgaze, In three cases the synkinesis was recognized only after failed ptosis surgery. Once recognized, two of these cases underwent further surgery with an excellent result. Three other patients all had successful surgery.Conclusions Superior rectus to levator synkinesis may be easily overlooked if eyelid elevation in upgaze is ascribed to normal levator function rather than a synkinetic movement. We draw attention to the importance of identifying this relatively common condition to plan appropriate ptosis surgery. The lack of levator muscle tone in the primary position of gaze means that an augmented resection of the levator muscle should be performed. Ophthalmology 2000;107:1975-1981 (C) 2000 by the American Academy of Ophthalmology.