경도 및 중등도 눈꺼풀처짐에서 결막뮐러근절제술과 눈꺼풀올림근널힘줄교정술 후 눈꺼풀윤곽 비교
Eyelid Contour Analysis Following Müller’s Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis
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목적: 경도 및 중등도 눈꺼풀처짐 환자에서 결막뮐러근절제술과 눈꺼풀올림근널힘줄교정술 후에 눈꺼풀 위치와 함께 윤곽의 변화를 비교하고자 하였다. 대상과 방법: 2012년 1월부터 2015년 12월까지 경도 ․ 중등도 눈꺼풀처짐으로 눈꺼풀처짐 교정술을 시행 받은 환자 중 최소 6개월 이상 추적관찰이 가능했던 결막뮐러근절제술을 시행 받은 16명(20안)과 눈꺼풀올림근널힘줄교정술을 시행 받은 17명(25안)을 대상으로 의무기록 및 수술 전후 사진을 후향적으로 비교 분석하였다. 수술 성공은 술 후 눈꺼풀각막반사간거리1 (marginal reflex distance 1, MRD1)이 2.5 mm 이상 상승한 경우 또는 양안 MRD1 차이가 0.5 mm 이하인 경우로 하였다. 눈꺼풀 윤곽은 MATLAB program (MathWorks, Natick, MA, USA)을 이용하여 동공 중심에서 눈꺼풀 테두리까지의 거리를 비측 수평선을 0o로 하여 15o마다 측정하였다. 결과: 결막뮐러근절제술 후 평균 교정량은 1.1 mm, 눈꺼풀올림근널힘줄교정술의 평균 교정량은 0.9 mm로 수술 전 MRD1, MRD2, 눈꺼풀올림근 기능, 눈썹위치 및 눈꺼풀윤곽은 차이가 없었다. 수술 성공률은 결막뮐러근절제술이 85%, 눈꺼풀올림근널힘줄교정술이 84%로 유의한 차이가 없었다. 술 후 눈꺼풀 윤곽은 상비측 15o에서 결막뮐러근절제술이 눈꺼풀올림근널힘줄교정술에 비해 눈꺼풀상승효과가 있었다(p<0.05). 결론: 경도 및 중등도 눈꺼풀처짐 환자에서 결막뮐러근절제술은 눈꺼풀올림근널힘줄교정술과 비교하였을 때, 눈꺼풀 전반에 걸쳐 눈꺼풀처짐 교정의 효과를 보였다. 따라서 페닐에프린 테스트에 양성인 경도 및 중등도 눈꺼풀처짐 환자에서 결막뮐러근절제술은 눈꺼풀 윤곽을 보존하는 유용한 교정술이 될 수 있을 것으로 여겨진다.
Abstract
Purpose: To analyze both the effects and the eyelid contour of Müller’s muscle-conjunctival resection and levator aponeurosis advancement in patients with mild to moderate belpharoptosis. Methods: We conducted a retrospective cross-sectional study including 20 eyes of 16 patients who underwent Müller’s muscle- conjunctival resection and 25 eyes of 17 patients who underwent levator aponeurosis advancement from January 2012 to December 2015, where each patient was followed up for at least 6 months. Surgical success was defined as either a marginal reflex distance 1 (MRD1) elevation greater than 2.5 mm postoperatively or a bilateral MRD1 difference less than 0.5 mm. Both the conventional and 12 oblique mid-pupil lid distances were measured every 15 degrees using custom software developed in the MATLAB program (MathWorks, Natick, MA, USA). Results: The average correction of Müller’s muscle-conjunctival resection was 1.1 mm, while that of levator aponeurosis advancement was 0.9 mm. There was no significant difference in MRD1, MRD2, function of levator palpebrae muscle, or lid contour in the preoperative status between the Müller’s muscle-conjunctival resection group and the levator aponeurosis advancement group. The surgical success rate was 85% in the Müller’s muscle-conjunctival resection group and 84% in the levator aponeurosis advancement group, but this difference was not significant. The postoperative lid contour (superomedial side, 15°) was more effective in the Müller’s muscle-conjunctival resection group (p < 0.05). Conclusions: Overall, both types of blepharoptosis surgery were effective at correcting mild to moderate blepharoptosis. The correction of mild to moderate blepharoptosis using Müller’s muscle-conjunctival resection is an effective technique for elevating the eyelid and normalizing the eyelid contour.
참고문헌 (21)
- Finesterer J, "Ptosis: causes, presentation, and management", Aesthetic Plast Surg, 27, pp.193~204 (2003)
- Escalas P, "Ptosis treated by resection of the Muller muscle: analysis of a series of 51 patients", J Fr Ophthalmol, 29, pp.908~915 (2006)
- Older JJ, "Levator aponeurosis surgery for the correction of acquired ptosis. Analysis of 113 procedures", Ophthalmology, 90, pp.1056~1059 (1983)
- Fasanella RM, "Levator resection for minimal ptosis: another simplified operation", Arch Ophthalmol, 65, pp.493~496 (1961)
- Putterman AM, "Müller muscle-conjunctiva resection. Technique for treatment of blepharoptosis", Arch Ophthalmol, 93, pp.619~623 (1975)
- Ben Simon GJ, "Muller's muscle-conjunctival resection for correction of upper eyelid ptosis: relationship between phenylephrine testing and the amount of tissue resected with final eyelid position", Arch Facial Plast Surg, 9, pp.413~417 (2007)
- Weinstein GS, "Modification of the Müller's muscle-conjunctival resection operation for blepharoptosis", Am J Ophthalmol, 93, pp.647~651 (1982)
- McCord CD Jr, "An external minimal ptosis procedure--external tarsoaponeurectomy", Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol, 79, pp.683~686 (1975)
- 박대일, "결막 뮬러근 절제술의 임상 결과와 수술 성공에 미치는 요인", 대한안과학회지, 52(11), pp.1263~1268 (2011), 대한안과학회
- Milbratz GH, "Multiple radial midpupil lid distances: a simple method for lid contour analysis", Ophthalmology, 119, pp.625~628 (2012)
- Guyuron B, "Experience with the modified Putterman procedure", Plast Reconstr Surg, 82, pp.775~780 (1988)
- Dresner SC, "Further modifications of the Müller's muscle-conjunctival resection procedure for blepharoptosis", Ophthal Plast Reconstr Surg, 7, pp.114~122 (1991)
- Mercandetti M, "Internal levator advancement by Müller's muscle-conjunctival resection: technique and review", Arch Facial Plast Surg, 3, pp.104~110 (2001)
- 배준성, "경도 눈꺼풀처짐 환자에서 결막뮬러근 절제술의 결과", 대한안과학회지, 49(9), pp.1365~1370 (2008), 대한안과학회
- Zauberman NA, "Müller's muscle-conjunctival resection for upper eyelid ptosis: correlation between amount of resected tissue and outcome", Br J Ophthalmol, 97, pp.408~411 (2013)
- Kim YS, "Comparison of two- and three-point sutures for advancing the levator aponeurosis in Asian eyelids", Eye (Lond), 29, pp.1181~1185 (2015)
- Liu D, "Ptosis repair by single suture aponeurotic tuck. Surgical technique and long-term results", Ophthalmology, 100, pp.251~259 (1993)
- Anderson RL, "Aponeurotic ptosis surgery", Arch Ophthalmol, 97, pp.1123~1128 (1979)
- Berlin AJ, "Levator aponeurosis surgery. A retrospective review", Ophthalmology, 96, pp.1033~1036 (1989)
- McCulley TJ, "Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis", Ophthal Plast Reconstr Surg, 19, pp.388~393 (2003)
- Shore JW, "Results of blepharoptosis surgery with early postoperative adjustment", Ophthalmology, 97, pp.1502~1511 (1990)