Simultaneous posterior eyelid ptosis repair and strabismus surgery: a single-stage approach

ABSTRACT Purpose: Blepharoptosis with coexisting strabismus can be observed in adults, and both these conditions affect cosmetic appearance and have psychosocial effects. Both also commonly require surgery, which is typically performed using a sequential approach. This study aimed to evaluate the efficacy of simultaneous Müller’s muscle-conjunctival resection with or without tarsectomy and strabismus surgery in adult patients with ptosis and coexisting strabismus. Methods: Patients with ptosis and coexisting strabismus who underwent simultaneous Müller’s muscle-conjunctival resection with or without tarsectomy and horizontal strabismus surgery were retrospectively evaluated. Analysis included measurement of the angle of deviation in prism diopters, margin reflex distance, eyelid height asymmetry, and complications following surgery. Success of Müller’s muscle-conjunctival resection with or without tarsectomy was defined as a margin reflex distance of ≥3.5 and ≤5 mm with a difference between the two upper eyelids of <1 mm. Strabismus success was defined as alignment with ±10 prism diopters of orthotropia. Results: The patients comprised three women and five men with a mean age of 37.12 years (range, 22-62 years). The strabismus stage of the surgery was performed first in all patients. Upper eyelid symmetry outcomes were assessed as perfect (<0.5 mm) in four patients and good (≥0.5 mm, <1 mm) in four patients. Success of Müller’s muscle-conjunctival resection with or without tarsectomy was achieved in six of eight patients (75%), and strabismus success was achieved in all patients. No revision eyelid or strabismus surgery was required following simultaneous surgery in any of the patients. Conclusion: Müller’s muscle-conjunctival resection with or without tarsectomy combined with strabismus surgery may be an alternative approach for use in patients with ptosis and coexisting strabismus.

摘要
目的：成人患者可同时罹患上睑下垂（Blepharoptosis）与斜视（strabismus），二者均会影响外观容貌，并产生社会心理层面的不良影响，且通常均需手术治疗，临床多采用分期手术方案。本研究旨在评估同时行穆勒肌结膜切除术（Müller’s muscle-conjunctival resection）联合或不联合睑板切除术（tarsectomy）联合斜视手术，治疗成人上睑下垂合并斜视患者的疗效。
方法：对同时接受穆勒肌结膜切除术联合或不联合睑板切除术与水平斜视手术的上睑下垂合并斜视患者进行回顾性分析。评估指标包括以棱镜度数（prism diopters）为单位的偏斜角测量、睑缘反射距离（margin reflex distance）、上睑高度不对称性以及术后并发症。穆勒肌结膜切除术联合或不联合睑板切除术的成功标准为：睑缘反射距离处于3.5 mm至5 mm之间，且双侧上睑高度差＜1 mm。斜视手术成功标准为：眼位矫正至正位视（orthotropia）±10棱镜度数范围内。
结果：本研究共纳入8例患者，其中女性3例、男性5例，平均年龄37.12岁（年龄范围22~62岁）。所有患者均先行斜视手术。上睑对称性评估结果为：4例患者达到完美对称（双侧高度差＜0.5 mm），4例达到良好对称（≥0.5 mm且＜1 mm）。8例患者中6例（75%）实现穆勒肌结膜切除术联合或不联合睑板切除术的手术成功，所有患者均实现斜视手术成功。所有患者在同期手术后均无需行眼睑或斜视矫正翻修手术。
结论：穆勒肌结膜切除术联合或不联合睑板切除术与斜视手术同期进行，可作为成人上睑下垂合并斜视患者的备选治疗方案。