不同程度不同年龄先天性上睑下垂患者手术前后眼散光量的变化

Changes of the amount of astigmatism before and after congenital ptosis in different age groups

摘要:

目的：对比不同程度、不同年龄先天性上睑下垂患儿手术前后角膜形态和散光的变化，为上睑下垂手术时机的选择、术后屈光矫正时间提供一定的临床依据。

方法：选取2015-09/2016-08在我院确诊为先天性上睑下垂并接受额肌腱膜悬吊术患者83例114眼(单眼52例，双眼31例)，收集其术前及术后1、3、6mo的角膜地形图和视网膜检影结果。对所有研究对象进行角膜地形图和10g/L阿托品眼用凝胶扩瞳后视网膜检影检查，对比分析不同程度、不同年龄段、不同随访时间患者手术前后眼散光量的变化。

结果：中重度上睑下垂术后角膜地形图测得角膜散光方向较术前比较，差异无统计学意义(P>0.05)。在3～<5岁年龄组，中重度上睑下垂术后6mo时Cyl和C值较术前减小。5～<12岁年龄组，中度上睑下垂Cyl术后1mo较术前明显增加后逐渐下降，术后6mo较术前低，但C值较术前增加； 重度上睑下垂术后1mo时Cyl值显著增加后逐渐下降，术后6mo较术前无明显变化，但C值较术前增加。

结论：3～<5岁先天性上睑下垂患者接受手术治疗，术后散光下降比例较大，是较适宜的手术年龄。上睑下垂术后早期散光变化较大，建议增加随访频率，及时进行屈光矫正。

Abstract:

AIM: To compare the changes of corneal shape and astigmatism before and after surgery in children with congenital ptosis in different degrees and different ages, and to provide a certain clinical basis for the timing of ptosis surgery and the time of refractive correction.

METHODS: The study consisted of 83 patients(114 eyes, 52 cases in one eye and 31 cases in both eyes)who were diagnosed with congenital ptosis and received frontalis muscle aponeurosis in our hospital from September 2015 to August 2016. The corneal topography and retinoscopy results were collected before and 1, 3, and 6mo after surgery. Corneal topography and 10g/L atropine ophthalmic gel retinoscopy were performed on all subjects, and the changes in the amount of astigmatism before and after surgery were compared between different degrees, different age groups, and different follow-up periods.

RESULTS: The corneal astigmatism measured by corneal topography after moderate to severe ptosis was not statistically different from that before the operation(P>0.05). In the 3 to less than 5 year old age group, cases with moderate to severe ptosis was observed after 6mo of Cyl, C value decrease compared with preoperative. In 5 to less than 12 year old age group, Cyl increased at first then decreased gradually 1mo after surgery compared with preoperative in patients with moderate ptosis, and decreased lower after surgery in 6mo, but C value increased compared with preoperative. In patients with severe ptosis, Cyl values showed a gradual decline after a significant increase in 1mo postoperatively, no significant changes compared with before surgery at 6mo, but the C value increased compared with preoperative.

CONCLUSION: Patients with congenital ptosis with 3 to less than 5 years of age undergo surgical treatment. The postoperative astigmatism has a large decrease, which is a suitable age for operation. The early astigmatism changes greatly after ptosis and it is recommended to increase the follow-up frequency and perform refractive correction in time.