helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2018-11-1-74-79helmholtzeyeinstitute-141Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУFOR OPHTHALMOLOGY PRACTITIONERSХирургическое лечение пациентов с миопатическим птозом верхних векSurgical treatment of patients with myopathic ptosisЗахароваМ. А.ZakharovaM. A.noemail@neicon.ruКатаевМ. Г.KataevM. G.noemail@neicon.ruФГАУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава РоссииРоссияSvyatoslav Fyodorov Eye MicrosurgeryRussian Federation2018031020181117479Copyright © Захарова М.А., Катаев М.Г., 20182018Захарова М.А., Катаев М.Г.Zakharova M.A., Kataev M.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/141

Цель работы - оценить результаты лечения пациентов миопатическим птозом верхних век, которые были прооперированы различными способами, и предложить алгоритм выбора метода лечения. Материал и методы. Проведен ретроспективный анализ 11 пациентов (10 женщин и 1 мужчина) в возрасте от 24 до 63 лет с миопатическим птозом верхних век. Хирургическое лечение включало подвешивающий тип операции с использованием мерсиленовой сетки (6 пациентов) при подвижности верхнего века ≤ 4 мм, резекцию леватора и мышцы Мюллера (5 пациентов) при подвижности верхнего века ≥5 мм. При наличии избытка кожи оба оперативных метода дополняли кожно-мышечной резекцией века. Результаты. Во всех случаях получены положительные значения послеоперационного показателя MRD1 (0,5-2 мм). Послеоперационный лагофтальм наблюдался у 2-х пациентов, которым была выполнена рецессия подвесок в ранние послеоперационные сроки. В одном случае через 12 месяцев произошло обнажение мерсиленовой сетки с обеих сторон. Заключение. Положительный эффект хирургического лечения миопатического птоза определяется раскрытием глазной щели до значения Marginal Reflex Distance 1 не менее 0 мм и полным отсутствием лагофтальма. Выбор метода лечения основывается на соотношении подвижности верхнего века и подвижности брови. При наличии избытка кожи оба оперативных метода дополняют кожно-мышечной резекцией века. Появление лагофтальма любой величины в послеоперационном периоде служит показанием для ранней корректирующей операции. Для цитирования: Захарова М.А., Катаев М.Г. Хирургическое лечение пациентов с миопатическим птозом верхних век. Российский офтальмологический журнал. 2018; 11 (1): 74-9. doi: 10.21516/2072-0076-2018-11-1-74-79.

Myopathic ptosis can occur in mitochondrial myopathies, oculopharyngeal muscular dystrophy or myotonic dystrophy and have common clinical characteristics. The management of myopathic ptosis is challenging due to a high risk of postoperative lagophthalmos. In this study, we report the results of surgical treatment in patients with myopathic ptosis. Purpose: to evaluate the results of treatment of patients with myopathic ptosis of the upper eyelids, operated in various ways, and propose an algorithm for choosing the method of treatment. Materials and methods. A retrospective study of 11 patients (10 females and 1 male) with myopathic ptosis was conducted. Surgical treatment included frontalis suspension using mersilene mesh with levator function ≤ 4 mm, (6 patients), resection of the levator and muscle of Muller with levator function ≥5 mm (5 patients). If excess skin of the upper eyelids was available, resection of the skin and orbicularis was additionally performed in both surgery techniques. Results. In all cases, positive values of the postoperative Marginal Reflex Distance (MRD1 = 0.5-2 mm) were obtained. Postoperative lagophthalmos was observed in two patients who underwent a recession of suspensions in an early postoperative period. In one case, the mersilene mesh was exposed on both eyes 12 months after surgery. Conclusion. The positive effect of the surgical treatment of myopathic ptosis is determined by eyelid opening to reach the values of MRD1 of at least 0 mm and a complete absence of lagophthalmos. The choice of the method of treatment is based on the correlation of levator function and the mobility of the eyebrows. In excess skin, both surgical methods are supplemented with skin and orbicularis resection. The appearance of any lagophthalmos in the postoperative period is an indication for an early corrective operation. For citation: Zakharova M.A., Kataev M.G. Surgical treatment of patients with myopathic ptosis. Russian ophthalmological journal. 2018; 11 (1): 74-9. doi: 10.21516/2072-0076-2018-11-1-74-79 (In Russian).

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The authors declare that there are no conflicts of interest present.