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2019, vol. 14, br. 3, str. 253-258
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Rezultati hirurških tehnika primenjenih u lečenju blefaroptoze
Results of surgical techniques applied in blepharoptosis
aUniversity of Health Sciences Haydarpasa Education and Research Hospital, Department of Ophthalmology, Istanbul, Turkey bBursa City Hospital, Department of Ophthalmology, Bursa, Turkey cUniversity of Health Sciences Dr. Lutfi Kirdar Kartal Education and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
e-adresa: yucellozturk@yahoo.com
Sažetak
Cilj: Naš cilj je bio da analiziramo stopu uspešnosti kod pacijenata koji su bili podvrgnuti operaciji aponeuroze levatora ili frontalnoj suspenziji sa silikonskim tračicama u odnosu na funkciju elevacije i da uporedimo naše rezultate sa literaturom. Materijal i metode: U ovu studiju smo uključili dvadeset i pet očiju 47 pacijenata koji su imali operaciju aponeuroze levatora ili frontalnu suspenziju sa silikonskim tračicama. Pacijenti su grupisani kao dobri, umereni i loši shodno funkciji levatora. Dobrim i umerenim pacijentima je rađena operacija aponeuroze levatora, dok je kod loših rađena frontalna suspenzijia sa silikonskim tračicama. Period praćenja nakon operacije bio je od 2 do 36 meseci. Rezultati su evaluirani u odnosu na rub kapka-refleks distance (MRD) i smatrani su uspešnim ukoliko je MRD veća od 2 mm, zadovoljavajući ako je između 1 i 2 mm i neuspešnim ako je manja od 1 mm. Rezultati: U ovu retrospektivnu studiju uključeno je 29 (61,7%) muškaraca i 18 (38,3%) žena, srednje životne dobi od 35,16 godina (0-84 godine). Trinaest slučajeva (27,7%) imalo je bilateralni oblik, a 34 slučaja jednostranu ptozu (72,4%). Osam od 13 pacijenata sa obostranom ptozom imalo je bilateralnu operaciju, a 5 njih je imalo jednostranu operaciju. Blefaroptoza je bila kongenitalna (60,0%), aponeurotska (19%), traumatska (1,8%), kod Hornerovog sindroma (1,8%) i miotone distrofije (1,8%). Srednja postoperativna vrednost MRD bila je 0.56 ± 0.85 mm (0-3 mm). Funkcija levatora bila je loša kod 18 očiju (32,7%), umerena kod 9 (16,4%), i dobra kod 28 očiju (50,9%). 37 pacijenata (67,3%) je podvrgnuto operaciji aponeuroze levatora, a 18 pacijenata imalo je frontalnu suspenziju sa silikonskim tračicama. U našim postoperativnim kontrolama, postignuti rezultati su bili uspešni kod 33 pacijenta, zadovoljavajući kod 3 i neuspešni kod 1 pacijenta. Diskusija: Operacija aponeuroze levatora i frontalna suspenzija sa silikonskim tračicama su obe efikasne hirurške metode za lečenje ptoze. Na postoperativni uspeh pozitivno utiče izbor hirurške metode u odnosu na funkciju levatora. Naši rezultati su pokazali da operacija aponeuroze levatora je sa boljim rezultatima kod dobrih i umerenih slučajeva, a frontalna suspenzija sa silikonskim tračicama je najbolja kod loših slučajeva.
Abstract
Objective: Our aim was to analyze the success rates of patients who underwent levator aponeurosis or frontal suspension with silicone tube surgery due to blepharoptosis according to the elevator function (LF) and to compare our results with the literature. Material and Methods: We included twenty-five eyes of 47 patients who had levator aponeurosis or frontal suspension with silicone tube surgery in this study. The patients were grouped as good, moderate, and poor according to their LF. Good and moderate patients had levator aponeurosis while poor patients had frontal suspension with silicon tube surgery. The follow-up period after surgery was 2 to 36 months. The results were evaluated with margin reflex distance (MRD) which greater than 2 mm was considered as successful, between 1 and 2 mm was satisfactory, and less than 1 mm was unsuccessful. Also, patients required revision surgery was considered as unsuccessful. Results: Twenty-nine (61.7%) men and 18 (38.3%) women with a mean age of 35.16 years (range = 0-84 years) were included in this retrospective study. Thirteen cases (27.7%) had bilateral, and 34 cases had unilateral ptosis(72.4%). Eight of the 13 patients with bilateral ptosis had bilateral and 5 of them had unilateral surgery. Blepharoptosis was due to congenital (60.0%), aponeurotic (19%), traumatic (1.8%), Horner's syndrome (1.8%) and myotonic dystrophy (1.8%). The preoperative mean MRD value was 0.56 ± 0.85 mm (0-3 mm). The levator function (LF) was poor in 18 eyes (32.7%), moderate in 9 eyes (16.4%) and good in 28 eyes (50.9%). Thirty-seven patients (67.3%) underwent levator aponeurosis, and 18 patients had frontal suspension with silicon tube surgery. In our postoperative controls, 33 patients were considered as successful. Three patients were considered as satisfactory, and one patient was considered unsuccessful. Discussion: Levator aponeurosis and frontal suspension with silicone tube surgeries are both effective surgical methods to treat ptosis. Postoperative success is positively affected by determining the surgery method, according to LF. Our results showed that elevator aponeurosis surgery is more satisfying in good and moderate cases, and frontal suspension with silicone tube is best in poor cases.
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