目的：探讨提上睑肌缩短术和额肌肌瓣悬吊术对患儿术后眼表和屈光状态的影响。

方法：选取2014-07/2016-06在我科进行先天性上睑下垂矫正术患儿121例146眼，术前根据患儿上睑下垂严重程度分为轻度组(47眼)、中度组(68眼)和重度组(31眼)； 根据患儿年龄分为<5岁组(104眼)和≥5岁组(42眼)； 根据手术方式分为提上睑肌缩短术组(提缩组62眼)和额肌肌瓣悬吊术组(悬吊组84眼)。比较两种手术方式对患儿术后眼表和屈光状态的影响差异，统计分析术前上睑下垂严重程度及年龄与患儿术后眼表和屈光状态关系。

结果：随访6mo内，提缩组和悬吊组患儿术后泪膜破裂时间(break-up time，BUT)、角膜平均曲率(keratometry，Km)和角膜散光度(astigmatism，Ast)比较，差异均无统计学意义(P>0.05)。术前上睑下垂轻度、中度、重度组中，矫正良好与欠佳例数相比差异有统计学意义(Z=-2.936，P=0.003)，且轻度组患儿矫正良好比例明显高于中、重度组(93.6% vs 83.8%和67.7%)； 三组患儿术后BUT(F=9.793，P=0.041)、Km(F=11.657，P=0.037)等指标均随着术前上睑下垂严重程度增加而呈降低趋势，而Ast指标呈升高趋势(F=28.417，P<0.01)，差异均具有统计学意义。此外，<5岁组患儿术后矫正良好眼数明显多于≥5岁组(χ²=4.082，P=0.043)； 且<5岁组患儿术后Km值更高(t=2.813，P=0.006)，Ast值明显低于≥5岁组(t=-7.741，P<0.01)，差异均具有统计学意义，而两组患儿术后BUT值比较，差异无统计学意义(P>0.05)。

结论：患儿提上睑肌缩短术和额肌肌瓣悬吊术术后角膜屈光力和散光情况均可得到明显改善，且术后初期存在一定程度角膜上皮损害，但一段时间后患儿眼表功能均能恢复到正常状态。患儿术前上睑下垂严重程度越低，术后眼表及屈光状态改善情况越佳。年龄对患儿术后眼表恢复情况无明显影响，但早期手术治疗可能更好地改善患儿屈光力和散光度。

METHODS: One hundred and twenty-one patients(146 eyes)for corrective surgery of congenital ptosis were selected in our department from July 2014 to June 2016. According to the severity of congenital ptosis, all the children divided into mild group(47 eyes), moderate group(68 eyes)and severe group(31 eyes). All the children were divided into group of less than 5 years old(104 eyes)and group of more than or equal to 5 years old(42 eyes)according to the age. According to the surgical approach, all the children divided into group of levator resection(62 eyes)and group of frontalis suspension(84 eyes). The effects of the two surgeries on the ocular surface and refractive were compared. The relationship between age, severity of postoperative ptosis and postoperative ocular surface, refractive of children were analyzed.

RESULTS: There were no significant differences in break-up time(BUT), keratometry(Km)and corneal astigmatism(Ast)in the levator resection group and frontalis suspension group(P>0.05). There was significant difference between the mild, moderate and severe group on the proportion of excellent corrected to uncorrected(Z=-2.936, P=0.003). The proportion of excellent correction in mild group was higher than that of moderate and severe group(93.6%, 83.8%and 67.7%). The indexes of BUT(F=9.793, P=0.041)and Km(F=11.657, P=0.037)in the three groups decreased with the increase of severity. While the Ast(F=28.417, P<0.01)showed an increasing trend, the difference was significant. In addition, the proportion of excellent correction in <5 year old group was significantly more than ≥5 years old group(χ²=4.082, P=0.043). The index of Km(t=2.813, P=0.006)was higher and Ast(t=-7.741, P<0.01)was lower in the <5 year old group. There was no significant difference in the index of BUT between the two groups after surgery(P>0.05).

CONCLUSION: The corneal refractive power and astigmatism can be improved similarly after treated with levator resection and frontalis suspension surgery. And there is some damage of corneal epithelial in the initial postoperation, but the function of ocular surface can return to normal after a period of time. The less severity of ptosis before surgery, the better improvement of ocular surface and refractive after sugery. There is no correlation between the age and postoperative ocular surface, but earlier surgical treatment may improve the children's refractive power and astigmatism and achieve greater benefits.