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Müller muscle-Conjunctival Resection (MMCR) Surgery: A Comprehensive Literature Review. Eur J Ophthalmol 2024:11206721241249505. [PMID: 38659353 DOI: 10.1177/11206721241249505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE This literature review aims to provide a comprehensive overview of the current understanding, indications, techniques, outcomes, and complications of Müller muscle-conjunctival resection (MMCR) surgery. It also addresses areas of debate with MMCR such as predictability concerning Phenylephrine response as well as the amount of muscle resection required. METHOD This literature review was compiled based on the available evidence from PubMed from 1975 to August 2023. RESULTS The success rate of MMCR ranges from 72% to 95%, with high patient satisfaction reported in most studies. The exact range of eyelid elevation after MMCR is variable, with a reported average of 2.1 mm MRD1 elevation. CONCLUSION MMCR is a well-established surgical technique used to correct upper eyelid ptosis that results from dysfunction or attenuation of the levator aponeurosis. MMCR proved to be a safe and effective procedure with a high patient satisfaction rate and low risk of complications.
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Comparisons of the Fusion Point of Orbital Septum and Levator Aponeurosis in Patients with and Without Mild Ptosis. Aesthetic Plast Surg 2024; 48:829-834. [PMID: 37610517 DOI: 10.1007/s00266-023-03544-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/23/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE By comparing the position of the fusion point between the oriental orbital septum and the levator aponeurosis of the upper eyelid in Asian without and with mild ptosis, this study explores the relationship between the fusion point and mild ptosis, providing scientific basis for better utilizing the orbital septum to correct mild ptosis. METHODS In this study, the outpatients who underwent double eyelid blepharoplasty with incision method in the plastic laser cosmetology department of Hunan Provincial People's Hospital from October 2018 to April 2019 were divided into the normal group and the mild ptosis group. The position of the fusion part of the orbital septum and the aponeurosis of the levator palpebrae superioris was observed in the two groups. There are three types of this position: the height of the fusion part is greater than the width of the tarsal plate, the height of the fusion part is equal to the width of the tarsal plate, and the height of the fusion part is less than the width of the tarsal plate. After the fusion part was exposed during the operation, the width of tarsal plate and the height of fusion part were measured with a scale. The difference of the location of fusion part between the two groups was analyzed. RESULTS The tarsal plate width was 11.061 ± 0.635 mm in the normal group and 11.062 ± 0.675 mm in the mild ptosis group. There was no significant difference in tarsal plate width between normal group and mild ptosis group (t = 0.645, p = 0.16). The height of the fusion part was 11.032 ± 0.646 mm in the normal group and 11.645 ± 0.429 mm in the mild ptosis group. The fusion position of mild ptosis group was higher than that of normal group (t = 3.769, P < 0.05). There was significant difference in the distribution of fusion site between the two groups (x2 =38.00, P < 0.0001). CONCLUSION The height of aponeurosis fusion of orbital septum and levator palpebrae superioris in mild ptosis group was higher than that in normal group, which may be the cause of mild ptosis. It is suggested that the appropriate treatment of orbital septum in clinical operation may be effective in the treatment of mild blepharoptosis. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .
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Hemorrhage Following Muller's Muscle Conjunctival Resection: Description and Case-Control Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00328. [PMID: 38285959 DOI: 10.1097/iop.0000000000002605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
PURPOSE The purpose of this study was to report a series of patients with postoperative hemorrhage after Muller's muscle conjunctival resection surgery and compare risk factors and outcomes with a control population. METHODS In this case-control study, records of patients who underwent Muller's muscle conjunctival resection over 5 years were reviewed for a history of postoperative hemorrhage occurring >24 hours after surgery. A 4:1 control population was matched for age and sex. Clinical data collected included demographics, medical history, medications, and subsequent surgery. Preoperative and 3-month postoperative marginal reflex distance 1 were measured digitally using ImageJ. The hemorrhage and control groups were compared using Fisher's exact tests for categorical variables and independent samples t tests for continuous variables. RESULTS The hemorrhage group contained 10 patients (mean age 66.4 ± 18.5 years). The control group consisted of 40 age and sex-matched controls. Of 350 charts reviewed, there were 10 cases of postoperative hemorrhage (incidence 2.9%). Hemorrhage occurred a mean of 4.2 ± 1.3 (range 2-7) days after surgery and lasted for a mean of 29.3 ± 19.1 (range 12-72) hours. In all 10 cases, the bleeding resolved with conservative measures. There was no difference between the hemorrhage and control groups in terms of medical conditions, blood thinners, and surgical revision. Preoperative, postoperative, and change in marginal reflex distance 1 did not differ between the hemorrhage and control groups. CONCLUSIONS Hemorrhage occurs approximately 4-5 days postoperatively in a small percentage of patients undergoing Muller's muscle conjunctival resection surgery. This investigation did not identify any consistent risk factors, and outcomes in this patient population appear no different than controls.
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Comparison of clinical outcomes of conjunctivo-mullerectomy for varying degrees of ptosis. Sci Rep 2023; 13:19131. [PMID: 37926725 PMCID: PMC10625983 DOI: 10.1038/s41598-023-46419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023] Open
Abstract
To compare the success of conjunctivo-mullerectomy in patients with varying degrees of ptosis and identify factors affecting outcomes and complications. The prospective cohort was studied in patients with ptosis undergoing conjunctivo-mullerectomy with or without tarsectomy were enrolled. Ptosis was classified as mild, moderate, and severe per margin-to-reflex distance 1 (MRD1). Postoperative MRD1, complications, and 3-month success rates were evaluated. The study enrolled 258 ptotic eyes of 159 patients. Most eyes (233; 90.3%) achieved surgical success, 14 (5.4%) were overcorrected, and 11 (4.3%) were undercorrected. The success rates for mild, moderate, and severe ptosis were 96.6%, 91.7%, and 83.5%, respectively. The mild and moderate ptosis groups had a nonsignificant difference in success (- 4.9%; 95% CI - 12.0% to 4.5%; P = 0.36). However, the mild and severe ptosis groups' rates significantly differed (- 13.1%; 95% CI - 23.6% to - 1.9%; P = 0.03). For all 3 ptosis groups, the success rates of individuals undergoing surgery without tarsectomy did not significantly differ. Patients undergoing conjunctivo-mullerectomy with tarsectomy had an increased risk of unsuccessful surgery (OR 3.103; 95% CI 1.205-7.986; P = 0.019). In conclusions, Conjunctivo-mullerectomy is safe and effective for all ptosis severities. The success rate was significantly lower for severe ptosis than mild or moderate ptosis. Levator muscle function was not associated with unsuccessful outcomes, but tarsectomy was.
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Efficacy of Müller's Muscle-conjunctival Resection With or Without Suturing for the Correction of Ptosis. Ophthalmic Plast Reconstr Surg 2023; 39:254-259. [PMID: 36305788 DOI: 10.1097/iop.0000000000002302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy of Müller muscle-conjunctival resection (MMCR) with or without suturing for the correction of ptosis. METHODS A retrospective chart review was performed of 30 patients (56 eyelids) undergoing sutureless (sMMCR) (34 eyelids) or conventional MMCR (cMMCR) (22 eyelids). Primary outcome measures were the change in MRD1 and vertical eyelid height (VLH). Secondary outcome measures were the amount of resection of MMCR (rMMCR) and postoperative symmetry of 1 mm or less. RESULTS In total, 49 eyelids (87.5%) had involutional ptosis and 7 (12.5%) had contactlens induced ptosis. The age and follow up between the sMMCR and cMMCR groups was, respectively, 65.1 ± 11.0 versus 65.5 ± 11.0 years and 4.0 ± 2.5 versus 6.5 ± 2.1 months. Preoperatively there were no significant differences noted between the sMMCR and cMMCR groups. Postoperatively there was a statistically significant difference in change of MRD1 between the sMMCR and cMMCR groups, 2.74 ± 0.20 mm and 2.02 ± 0.25 mm ( p = 0.026). The difference in change of VLH and rMMCR was not significant between the sMMCR and cMMCR groups, 2.28 ± 0.13 mm and 2.14 ± 0.15 mm ( p = 0.49) and 9.29 ± 2.14 versus 9.46 ± 1.97 mm ( p = 0.83). There were no significant differences in postoperative symmetry. CONCLUSION The sMMCR and cMMCR techniques demonstrated equal effectiveness for the correction of ptosis. The rapid sMMCR could become the procedure of choice for the correction of involutional and contact lens induced ptosis.
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Müller Muscle Conjunctival Resection: A Multicentered Prospective Analysis of Surgical Success. Ophthalmic Plast Reconstr Surg 2023; 39:226-231. [PMID: 36356179 DOI: 10.1097/iop.0000000000002292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE This is a multicenter prospective cohort study investigating Müller muscle conjunctival resection success rates based on marginal reflex distance-1 (MRD1) and symmetry criteria. A secondary objective was to identify predictors of success. METHODS One hundred fifty-two patients with unilateral or bilateral blepharoptosis (229 eyelids) undergoing Müller muscle conjunctival resection were consecutively recruited from 2015 to 2020 at the Université de Montréal and University of California San Francisco. Ptosis was defined as MRD1 ≤ 2.0 mm or MRD1 > 1 mm lower than the contralateral eyelid. Patients were selected for Müller muscle conjunctival resection surgery if they demonstrated significant eyelid elevation following phenylephrine 2.5% testing. MRD1 success (operated eyelid achieving MRD1 ≥ 2.5 mm) and symmetry success (patient achieving an intereyelid MRD1 difference ≤ 1 mm) were evaluated for the patient cohort. Predictors of MRD1 and symmetry success were analyzed using multivariate regression analysis. RESULTS MRD1 success was achieved in 72.1% (n = 165) of 229 operated eyelids. Symmetry success was achieved in 75.7% (n = 115) of 152 patients. MRD1 before phenylephrine testing was the only statistically significant predictor of MRD1 success (odds ratio [OR] 2.69, p = 0.001). Symmetry following phenylephrine testing was the only variable associated with increased odds of symmetry success (OR 2.71, p = 0.024), and unilateral surgery (OR 0.21, p = 0.004), the only variable associated with reduced odds of symmetry success. CONCLUSIONS Müller muscle conjunctival resection effectively achieves postoperative MRD1 and symmetry success. MRD1 before phenylephrine testing is the strongest determinant of MRD1 success. Neither a large rise in MRD1 with phenylephrine nor increasing tissue resection length adequately counterbalance the effect of a low MRD1 before phenylephrine. Unilateral surgery and the absence of symmetry following phenylephrine predict greater odds of symmetry failure.
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Optimizing Management of Asymmetric Ptosis: A Comparison of Three Posterior Approach Resection Algorithms. Ophthalmic Plast Reconstr Surg 2023; 39:72-75. [PMID: 36095846 DOI: 10.1097/iop.0000000000002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy of 3 resection algorithms in the management of patients with asymmetric ptosis. METHODS Patients undergoing bilateral Muller's muscle-conjunctival resection (MMCR) were identified. Standardized preoperative clinical photographs were examined and margin reflex distance 1 (MRD1) was measured using ImageJ. Patients presenting with ≥1 mm of asymmetry in MRD1 were included. Three groups were identified: variable (4:1 ratio, with the lower side receiving a greater resection), fixed (7 mm resection bilaterally), and tarsectomy (7 mm bilaterally + 1 mm of tarsus resected on the lower preoperative side). Postoperative MRD1 was measured from photographs obtained 3 months after surgery. The primary outcome was postoperative asymmetry. RESULTS A total of 95 patients with a mean age of 71.0 ± 11.0 years were included. There was no significant difference in age ( p = 0.277) or length of follow-up ( p = 0.782) between the groups. Although the fixed tarsectomy group had significantly greater preoperative asymmetry ( p = 0.001), there was no significant difference in postoperative asymmetry ( p = 0.166). On multivariate analysis, preoperative asymmetry was the only significant predictor of postoperative asymmetry ( p < 0.001). Specifically, the surgical group was not a predictor of the primary outcome ( p = 0.723). CONCLUSIONS Resection amount and technique did not predict postoperative outcomes in cases of asymmetric ptosis. This may support the hypothesis that changes in eyelid position and symmetry following MMCR is due to a dynamic system, rather than as a result of purely mechanical forces.
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Revision ptosis surgery for under-correction after Müller muscle conjunctival resection. J Plast Reconstr Aesthet Surg 2022; 75:3485-3490. [DOI: 10.1016/j.bjps.2022.04.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022]
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Outcomes of Single Suture Mueller's Muscle Conjunctival Resection: Ethnic Considerations. Ophthalmic Plast Reconstr Surg 2022; 38:50-52. [PMID: 34085991 DOI: 10.1097/iop.0000000000001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare outcomes of Mueller's Muscle Conjunctival Resection (MMCR) between 2 groups of patients with different anatomy due to ethnic heritage. METHODS The medical records of patients who underwent MMCR between 2013 and 2018 were retrospectively reviewed. Patients who underwent additional procedures, such as upper blepharoplasty and browplasty, were excluded from the study. Patients were divided in 2 groups based on self-identified ethnic groups (Asian and Caucasian). Image J software was used to calculate MRD1 from digital images. The improvement of MRD1 (net MRD1) after surgery was evaluated and compared between 2 groups. RESULTS Eighty-three eyes of 68 patients were included in this study. The Asian group consisted of 41 eyelids from 28 patients. The Caucasian group consisted of 42 eyelids from 40 patients. The average age was 52.18 (SD 20.176) in the Asian group compared with the 66.45 years (SD 9.22, p < 0.005) in the Caucasian group. The mean improvement of MRD1 was 1.96 ± 0.75 mm in Asian group and 2.05 ± 0.72 mm in Caucasian group, which was not statistically significant (p = 0.62). The incidence of ptosis overcorrection and undercorrection between the groups was also not statistically significant. CONCLUSIONS There was no statistically significant difference in the surgical outcomes among the 2 study groups. Despite differences in the anatomy of Caucasian and Asian eyelids, MMCR is a successful procedure in patients self-identified from both ethnic groups.
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Postoperative Clinical Outcomes Using Standard Variables Following Levator-Mullerectomy Advancement Blepharoptosis Surgery. J Craniofac Surg 2021; 32:e554-e556. [PMID: 33606440 DOI: 10.1097/scs.0000000000007554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The Muller muscle-conjunctival resection is a common technique used to treat blepharoptosis, but there is variability with the target surgical resection and expected postoperative outcomes measured by marginal reflex distance-1 (MRD1). A Levator-Mullerectomy is a novel surgical approach described by Morris et al to incorporate the levator palpebrae superioris in the same incision as the classic Muller muscle-conjunctival resection in the treatment of blepharoptosis. This a retrospective study of patients who underwent Levator-Mullerectomy for ptosis repair showing the clinical outcomes based on MRD1. Statistical analysis was performed using analysis of variance and a nonparametric Kruskal-Wallis test. One hundred-twelve eyes of 83 patients (29 bilateral cases) with a mean age 64.6 years (7-92 years) were included. The types and prevalence of blepharoptosis were involutional (83%), neurogenic (8.0%), traumatic (3.6%), apraxia (2.7%), and congenital (2.7%). There was no significant difference in clinical outcome based on type of blepharoptosis (P = 0.7). Target resection lengths of 8 mm, 10 mm, and 12 mm were compared with postoperative MRD1 change. The mean change in MRD 1 between 8 mm and 10 mm was found to be statistically significant (P = 0.001 for both) but was not statistically significant for the 12 mm resection (P = 0.8). In patients with blepharoptosis and a positive response to 2.5% phenylephrine can benefit from Levator-Mullerectomy with either an 8 mm or 10 mm resection. This novel surgical approach allows surgeons to produce a more predictable and consistent clinical outcome.
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Predictability of the Phenylephrine Test With Regard to Eyelid Skin Appearance in Patients Who Undergo Müller Muscle-Conjunctival Resection Without Blepharoplasty. Ophthalmic Plast Reconstr Surg 2021; 36:191-193. [PMID: 31809484 DOI: 10.1097/iop.0000000000001510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the ability of preoperative phenylephrine testing to predict postoperative upper eyelid tarsal platform show in patients undergoing Müller muscle-conjunctival resection (MMCR) ptosis repair without concurrent blepharoplasty. METHODS A retrospective chart review was performed on 52 eyelids of patients who underwent MMCR without external skin incision. Photographs were reviewed to objectively and subjectively compare the results of phenylephrine testing to postoperative appearance. Only patients who underwent successful MMCR were included in the study. The authors defined successful MMCR as having a resulting marginal reflex distance within 1 mm of that predicted by phenylephrine testing. For objective analysis, the tarsal platform show was measured using computer software. For subjective analysis, 2 experienced examiners were asked to grade the correlation in appearance on a scale of 1-5 (1 being poor correlation and 5 being excellent correlation). RESULTS The mean tarsal platform show in the phenylephrine test photographs and the postoperative photographs was 3.8 and 3.63 mm, respectively (mean = 0.17; standard deviation = 0.71). The difference between the means was not statistically significant (p > 0.05). The mean difference in tarsal platform show between phenylephrine testing and postoperative was 0.17 mm (standard deviation = 0.71). The difference was not statistically significant (t[51] = 0.09; p > 0.05; 2 tailed). The mean subjective correlation score comparing phenylephrine testing photographs to postoperative photographs was 4.4 out of possible 5. CONCLUSIONS Phenylephrine testing exhibits good predictability with regard to eyelid appearance after successful MMCR without external skin incision and, therefore, may assist the surgeon when trying to decide if blepharoplasty or eyelid crease formation is necessary at the time of MMCR.
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Blepharoptosis Repair: External Versus Posterior Approach Surgery: Why I Select One over the Other. Facial Plast Surg Clin North Am 2021; 29:195-208. [PMID: 33906756 DOI: 10.1016/j.fsc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ptosis surgery is performed via an anterior/external or posterior/internal approach, primarily defined by the eyelid elevator muscle surgically addressed: the levator complex anteriorly or Muller muscle posteriorly. Posterior ptosis surgery via Muller muscle conjunctival resection is an excellent first choice for cases of mild to moderate ptosis with good levator function, as it is predictable, provides a reliable cosmetic outcome, requires no patient cooperation during surgery, portends a lower rate of reoperation, and rarely leads to lagophthalmos and/or eyelid retraction postoperatively. External levator resection is preferred in patients with severe ocular surface/cicatricial conjunctival disease, shortened fornices, and lesser levator function.
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Efficacy and predictability of Muller's muscle-conjunctival resection with different tarsectomy lengths for unilateral blepharoptosis treatment. BMC Ophthalmol 2021; 21:83. [PMID: 33579223 PMCID: PMC7881611 DOI: 10.1186/s12886-021-01849-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the efficacy and predictability of Muller's muscle-conjunctival resection (MMCR) with different lengths of tarsectomy for the treatment of unilateral mild-to-moderate blepharoptosis. METHODS A retrospective study of patients who underwent MMCR with tarsectomy for unilateral mild-to-moderate blepharoptosis between January 2016 and December 2019 was performed. Individuals with adequate photographic documentation and good levator function were included. Data on age, gender, surgical designs, pre-operative and post-operative marginal reflex distance 1 (MRD1) and tarsal platform show (TPS), and complications were retrieved. RESULTS Sixty patients underwent 8-mm MMCR with 1- or 2-mm tarsectomy; 53 patients (88.3%) showed postoperative symmetry of MRD1 within 1 mm. The average postoperative improvement in MRD1 was 2.15 ± 0.8 mm. Thirty-two patients received 8-mm MMCR with 1-mm tarsectomy (group 1), and 28 patients underwent 8-mm MMCR with 2-mm tarsectomy (group 2). In group 1, postoperative symmetry rate was 90.6%, and the mean elevation of MRD1 was 1.66 ± 0.6 mm. In group 2, postoperative symmetry rate was 85.7%, and the mean elevation of MRD1 was 2.72 ± 0.6 mm. Both groups showed postoperative symmetry of TPS and significant improvement in eyelid position (p < 0.0001). No postoperative complication was noted, and no secondary surgery was needed. CONCLUSIONS MMCR with tarsectomy was proven to be a safe, rapid, and effective method for patients with mild-to-moderate ptosis. Predictability and symmetry of the outcome were statistically confirmed. We further suggest a 2.1-mm expected MRD1 elevation as a cut point for choosing between 1- or 2-mm tarsectomy.
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Effect of topical Phenylephrine on the upper eyelid crease position. Acta Ophthalmol 2020; 98:e1024-e1027. [PMID: 32378788 DOI: 10.1111/aos.14458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/10/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the effect of Phenylephrine test on the upper eyelid crease position. MATERIAL AND METHODS This study follows a prospective and analytical design and included patients with unilateral acquired involutional ptosis recruited between January 2015 and January 2018. In the Phenylephrine test, 1 drop of Phenylephrine 10% was instilled on the inferior fornix of the ptotic eye and the eyelid crease position was evaluated 10 min after. RESULTS A total of 60 patients were included in the final sample. The mean Margin-to-reflex distance 1 (MRD1) of the ptotic eye was 2.1 ± 1.0 and 3.8 ± 0.6 mm before and 10 min after the instillation of Phenylephrine, respectively. The difference between the means was statistically significant (p < 0.001). Ninety-five per cent of the eyes had a positive Phenylephrine test result. Of this, 100% showed a decrease in the height of eyelid crease after the drop. There was a statistically significant decrease in the height of eyelid crease from 10.3 ± 2.5 to 7.8 ± 2.0 mm (p < 0.001). CONCLUSION Phenylephrine test not only affects the eyelid position but also the eyelid crease height. We show a significative decrease in eyelid crease height to a symmetrical level with the contralateral lid in all patients that had a positive Phenylephrine test result. This effect is probably due to a posterior lamella shortening secondary to Müller's muscle contraction and suggests that the eyelid crease is not only determined by the projections of levator aponeurosis, but also by the entire force vector of the upper eyelid retractors.
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Abstract
Conventional levator aponeurosis plication is a widely accepted technique for correction of mild to moderate ptosis. However, this method is associated with a high recurrence rate. The objective of this study was to investigate the clinical efficacy of levator aponeurosis posterior layer plication technique for correction of mild to moderate ptosis.A convenience sampling approach was used to recruit 450 patients with mild to moderate blepharoptosis at the Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital between August, 2015 and December, 2017. All participants were treated with levator aponeurosis posterior layer plication technique. The primary outcome was the postoperative change in marginal reflex distance 1 (MRD1). The paired t test was used to determine the clinical efficacy. Outcomes were assessed at 1 week, 1 month, 3 months, and 6 months after surgery.The mean preoperative MRD1 was 1.7 ± 0.5 mm, and the mean postoperative MRD1 at 6-month follow-up was 3.7 ± 0.4 mm (P < .0001). According to the postoperative survey, 427 (94.9%) patients were satisfied with surgical outcomes.This modified levator aponeurosis plication technique is a simple and effective procedure for correction of mild to moderate blepharoptosis. It results in good MRD1 and high patient satisfaction.
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Predictors of Success Following Müller’s Muscle-Conjunctival Resection. Ophthalmic Plast Reconstr Surg 2018; 34:483-486. [DOI: 10.1097/iop.0000000000001065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Change in Eyelid Position Following Muller's Muscle Conjunctival Resection With a Standard Versus Variable Resection Length. Ophthalmic Plast Reconstr Surg 2018; 34:355-360. [PMID: 28914711 DOI: 10.1097/iop.0000000000000997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study compares the use of a standard 7 mm resection length to a variable 4:1 ratio of resection length to desired elevation nomogram when performing Muller's muscle conjunctival resection surgery. METHODS In this cross-sectional case control study, 2 groups were defined. The first underwent Muller's muscle conjunctival resection surgery with a standard 7 mm resection length and the second underwent the same surgery with a variable resection length determined by a 4:1 ratio of resection length to desired elevation nomogram. Groups were matched for age (within 5 years) and sex. Pre- and postoperative photographs were measured digitally. Change in upper marginal reflex distance 1 (MRD1) and final MRD1 were the primary outcome measures. The study was powered to detect a 1 mm difference in MRD1 to a beta error of 0.95. RESULTS No significant preoperative differences between the groups were noted. No significant difference in final MRD1 (0.1 mm; p = 0.74) or change in MRD1 (0.2 mm; p = 0.52) was noted. Mean resection length to elevation ratios were 3.9:1 for standard group and 4.3:1 for the variable group (p = 0.54). CONCLUSION The authors were not able to detect a significant difference in final MRD1 or change in MRD1 for patients undergoing Muller's muscle conjunctival resection surgery with standard or variable resection lengths. These results tend to argue against a purely mechanical mechanism for Muller's muscle conjunctival resection surgery.
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Efficacy of Muller's Muscle and Conjunctiva Resection With or Without Tarsectomy for the Treatment of Severe Involutional Blepharoptosis. Ophthalmic Plast Reconstr Surg 2017; 33:273-278. [PMID: 27429227 DOI: 10.1097/iop.0000000000000748] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine if Muller's muscle and conjunctiva resection with or without tarsectomy is an efficacious procedure for the treatment of severe involutional blepharoptosis. METHODS A retrospective chart review was performed for all consecutive patients with severe involutional blepharoptosis during a 12-year period treated by a single surgeon (AMP) with a Muller's muscle and conjunctiva resection with or without tarsectomy. The inclusion criteria was good levator function (≥10 mm eyelid excursion), adequate response to phenylephrine (change in eyelid height ≥1.5 mm), and severe involutional blepharoptosis (margin-to-reflex-distance-1 ≤0 mm). RESULTS One hundred eyelids of 69 patients were identified that met the inclusion criteria. Mean preoperative margin-to-reflex-distance-1 was -0.65 mm and mean postoperative margin-to-reflex-distance-1 was 3.00 mm for all patients. For patients treated with Muller's muscle and conjunctiva resection without tarsectomy, mean preoperative and postoperative margin-to-reflex-distance-1 was -0.51 mm and 2.98 mm with 97.5% of the patients obtaining a lift greater than 1.5 mm. CONCLUSIONS The results demonstrate that Muller's muscle and conjunctiva resection with or without tarsectomy does provide another alternative to the surgeon for the management of severe involutional blepharoptosis.
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Abstract
Congenital blepharoptosis, caused by levator muscle dysgenesis, presents at birth and may lead to disturbed visual development and function. Other causes of ptosis in pediatric patients can be myogenic, neurogenic, mechanical, or traumatic. Timely correction is, therefore, critical, and careful preoperative planning and intraoperative considerations are crucial to achieve optimal outcomes and minimize potential complications. The various surgical techniques, including the frontalis suspension or sling, levator resection and advancement, Müller's muscle conjunctival resection (the Putterman procedure), and modified Fasanella-Servat procedure are each associated with distinct indications, benefits, and drawbacks, necessitating a unique tailored approach to each surgical candidate.
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Eyelid Contour Analysis Following Müller's Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.6.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The 90-degree rule in posterior ptosis surgery. Int Ophthalmol 2015; 36:243-6. [PMID: 26253459 DOI: 10.1007/s10792-015-0108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 08/04/2015] [Indexed: 11/24/2022]
Abstract
To propose a guideline for ptosis clamp positioning to minimize the risk of globe injury during posterior ptosis surgery. Measurements of 20 consecutive patients, 40 eyelids, undergoing bilateral posterior ptosis repair surgery were taken; as a surrogate for needle tip position, measurement of the distance from the clamp base to the ocular surface was taken using a caliper with the clamp held at 90-degrees to the ocular surface and again at 45-degrees to the ocular surface. These measurements were compared to geometric predictions of the distance from the clamp base to the ocular surface. The average distance from the clamp base to the ocular surface when the clamp is held 90-degrees to the ocular surface was 7 mm, this distance decreases to 5 mm when the clamp is held 45° to the ocular surface. This coincides well with geometric predictions. Posterior ptosis surgery overall has an excellent safety profile; however, complications are possible, perhaps the most severe of which is inadvertent globe and/or corneal injury. The more acute the angle the ptosis clamp is held, the closer the clamp base, and subsequently the needle tip, is to the ocular surface as would be predicted geometrically. This coincides with closer proximity of the needle to the ocular surface during surgery. The theoretical risk of globe injury should decrease as the distance of the needle from the globe increases, and this distance is greatest when the clamp is held at a 90-degree angle to the ocular surface. This distinction becomes particularly important to consider in large eye morphology patients where the distance from the needle to the globe can approach 2 mm when the clamp is held at 45-degrees.
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The role of tissue resection length in the determination of post-operative eyelid position for Muller's muscle-conjunctival resection surgery. Orbit 2015; 34:92-98. [PMID: 25804327 DOI: 10.3109/01676830.2014.999096] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To investigate the relationships between pre-operative marginal reflex distance (MRD), tissue resection length, phenylephrine response, and change in MRD with surgery for a cohort of individuals undergoing Muller's muscle conjunctival resection (MMCR) surgery. METHODS All cases of MMCR surgery performed over a 13-year period at a single institution were screened for entry. Individuals with adequate photographic documentation and follow up were included. Patients with previous or concurrent upper eyelid, orbital or eyebrow disease of surgery were excluded. Marginal reflex distance (MRD) was calculated based on photographs utilizing public domain software. Data was plotted for inspection and appropriate statistical tests were performed. RESULTS During the study period 198 eyes fit criteria for analysis. A loose association between tissue resection length and change in MRD with surgery was found (r = 0.176, p < 0.05); this relationship was not significant in ANOVA analysis (p = 0.367). There was a strong association between MRD change with surgery and pre-operative MRD (r = 0.498, p < 0.01). Approximately 28% of the sample responded to 2.5% phenylephrine drop instillation with a greater than 2 mm increase in MRD. The response to phenylephrine was strongly associated with pre-operative MRD (r = -0.441, p < 0.01). A regression on change in MRD with surgery with tissue resection, phenylephrine response >2 mm and pre-operative MRD as variables revealed a model with pre-operative MRD as the only significant predictor (p < 0.01). CONCLUSION Tissue resection length and phenylephrine response play small roles relative to pre-operative MRD in the determination of change in MRD with MMCR surgery.
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The significance of minimal adjustments in the Muller's muscle and conjunctiva resection procedure to achieve the phenylephrine result. Orbit 2015; 34:79-83. [PMID: 25804407 DOI: 10.3109/01676830.2014.999287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine if adjusting the resection amount within a small range has a significant effect in the amount of lift achieved when performing the Muller's muscle and conjunctiva resection procedure (MMCR). METHODS A retrospective chart review was performed analyzing 102 eyelids of 68 patients with involutional blepharoptosis that had a MMCR resection amount ranging from 8.0-9.5 mm performed by a single surgeon (P.S.) RESULTS The average lift for all resections was 2.30 mm. When comparing amongst all resection groups, there was no significant difference in the amount of lift obtained (p = 0.2454). CONCLUSION When performing the MMCR procedure, adjusting the resection amount within a small range of 8.0-9.5 mm does not affect the amount of lift achieved.
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Surgical correction of blepharoptosis using a modified levator aponeurosis-Müller muscle complex reinsertion technique. J Craniofac Surg 2014; 25:226-30. [PMID: 24406583 DOI: 10.1097/scs.0000000000000371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the outcomes after ptosis correction surgery using a modified levator aponeurosis-Müller muscle complex reinsertion technique. In this clinical study, 75 eyelids of 49 patients with congenital blepharoptosis were treated with the modified technique. The results, including complications, were followed up and evaluated. Operation was performed via anterior transcutaneous incision. After separating the preseptal orbicularis oculi muscle, the levator complex, including Müller muscle and the levator aponeurosis, was visualized. The levator complex was cut into 2 parts at the top of the conjunctival fornix to create an upper portion and a lower portion. The detached lower portion of the complex flap combined with the tarsal plate was advanced superiorly and reinserted into the posterior aspect of the upper portion of the complex flap by using 3 horizontal mattress sutures. Preoperative ptosis severity was compared with the degree of ptosis correction using the Cochran-Mantel-Haenszel test. Preoperative levator function was compared with the degree of ptosis correction and the postoperative levator function using Fisher exact test for paired data. Sufficient postoperative correction of ptosis was achieved in 78.7% of eyelids. Postoperative levator function of more than 4 mm was achieved in 82.7% of all eyelids that underwent surgery. We conclude that the modified levator aponeurosis-Müller muscle complex reinsertion technique is effective for correcting congenital blepharoptosis, especially in patients with fair to good (>4 mm) preoperative levator function.
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Ten years' experience with unilateral conjunctival mullerectomy in the Asian eyelid. Plast Reconstr Surg 2014; 133:879-886. [PMID: 24378348 DOI: 10.1097/prs.0000000000000050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to report 10 years of experience with unilateral conjunctival mullerectomy in the Asian eyelid. METHODS Medical records of patients with unilateral ptosis who underwent conjunctival mullerectomy performed by a single surgeon from January of 2001 to December of 2011 were reviewed. The following factors were investigated: preoperative marginal reflex distance-1 of the ptotic and contralateral normal eyelids, levator function, and preoperative marginal reflex distance-1 after instillation of 2.5% phenylephrine of the ptotic eye. Main outcome measures were the surgical success rate of conjunctival mullerectomy, comparison of preoperative factors according to surgical results, and the results of univariate and multiple logistic regression analyses to identify the factors associated with undercorrection of conjunctival mullerectomy. RESULTS Of a total of 64 eyes (64 patients), 53 eyes (82.8 percent) showed surgical success, two eyes (3.1 percent) showed overcorrection, and nine eyes (14.1 percent) showed undercorrection. The mean preoperative marginal reflex distance-1 difference between both eyes was 2.20 mm in the undercorrection group and 1.40 mm in the surgical success group (p = 0.001). The percentage of patients in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid was 88.9 percent (eight of nine eyes) in the undercorrection group, and 28.3 percent (15 of 53 eyes) and 0 percent (zero of two eyes) in the surgical success and overcorrection groups, respectively (p = 0.001). Multiple logistic regression analysis showed that patients in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid were associated with an increased risk of undercorrection after conjunctival mullerectomy (OR, 10.740; 95 percent confidence interval, 1.098 to 15.431; p = 0.041). We observed 0.18 ± 0.08-mm lid elevation per 1 mm of conjunctival mullerectomy. CONCLUSIONS Conjunctival mullerectomy can be successfully performed to correct unilateral ptosis in the Asian eyelid in 82.8 percent of patients. Patients with greater degrees of preoperative ptosis and those in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid have a higher possibility of undercorrection. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
PURPOSE To assess current practice patterns for management of ptosis by current ASOPRS members. METHODS An invitation to participate in a web-based, anonymous survey was sent to current members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS) via e-mail. The survey consisted of 4 sections: preoperative testing of ptosis patients, surgical preferences, dry eye evaluation in ptosis patients, and length of postfellowship practice. Responses were analyzed using standard statistical methods. RESULTS Fifty percent of ASOPRS members performed more than 100 ptosis procedures in the past year. Most ASOPRS members performed preoperative photography, automated perimetry testing, and phenylephrine testing in evaluation of ptosis patients. A slight majority of ASOPRS members did not use preoperative Schirmer testing as the primary screening tool for dry eye disease. Most ASOPRS members performed internal levator aponeurosis advancement surgery, although most surgeons performing concurrent ptosis repair and blepharoplasty preferred an external approach. Frontalis sling surgery was performed using a wide variety of materials for suspension. CONCLUSION Current trends in the management and preoperative evaluation of blepharoptosis by ASOPRS members revealed a number of interesting common practices that are of value to current practitioners.
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Abstract
Ptosis refers to vertical narrowing of the palpebral fissure secondary to drooping of the upper eyelid to a lower than normal position. Ptosis is considered congenital if present at birth or if it is diagnosed within the first year of life. Correction of congenital ptosis is one of the most difficult challenges ophthalmologists face. Multiple surgical procedures are available including, frontalis sling, levator advancement, Whitnall sling, frontalis muscle flap, and Mullerectomy. Selection of one technique over another depends on the consideration of several factors including the surgeon experience, the degree of ptosis in the patient, as well as the degree of levator muscle function. Current recommendations for the correction of congential ptosis vary based on clinical presentation. Advantages and disadvantages of each of these procedures are presented with recommendations to avoid complications.
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A Histological Analysis of the Müllerectomy: Redefining Its Mechanism in Ptosis Repair. Plast Reconstr Surg 2011; 127:2333-2341. [DOI: 10.1097/prs.0b013e318213a0cc] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinical Outcomes of Conjunctiva-Müller Muscle Resection and Factors Which Affect Success. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.11.1263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Transconjunctival blepharoptosis surgery: a review of posterior approach ptosis surgery and posterior approach white-line advancement. Open Ophthalmol J 2010; 4:81-4. [PMID: 21339897 PMCID: PMC3040997 DOI: 10.2174/1874364101004010081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 06/25/2010] [Accepted: 07/19/2010] [Indexed: 11/22/2022] Open
Abstract
Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator palpebrae superioris (LPS) muscle. A review of the literature demonstrates how surgery has evolved since Blaskovics' first described his technique in 1923. We describe our newer method of posterior approach white-line advancement blepharoptosis repair which is now an option in the majority of aponeurotic ptosis with moderate to good levator function.
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Müller's Muscle Conjunctival Resection Ptosis Repair in the Aesthetic Patient. Saudi J Ophthalmol 2010; 25:51-60. [PMID: 23960902 DOI: 10.1016/j.sjopt.2010.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 10/06/2010] [Indexed: 10/19/2022] Open
Abstract
Posterior eyelid ptosis repair via the Müller's muscle-conjunctival resection procedure is an effective, reliable, and simple technique for periorbital rejuvenation in the aesthetic patient. This procedure may be performed with other periorbital rejuvenation techniques without sacrificing results. Appropriate candidates are patients with maintained levator function whose ptotic upper eyelid elevates close to a normal eyelid level upon instillation of phenylephrine drops to the superior conjunctival fornix.
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Surgical Microanatomy of the Müller Muscle-Conjunctival Resection Ptosis Procedure. Ophthalmic Plast Reconstr Surg 2010; 26:360-4. [DOI: 10.1097/iop.0b013e3181cb79a2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Müller Muscle Conjunctival Resection for Blepharoptosis in Patients With Poor to Fair Levator Function. Ophthalmic Surg Lasers Imaging Retina 2009; 40:597-9. [DOI: 10.3928/15428877-20091030-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2008] [Indexed: 11/20/2022]
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Abstract
PURPOSE To describe periorbital changes induced by chronic topical therapy with daily bimatoprost 0.03% (Lumigan, Allergan Inc., Irvine, CA, U.S.A.). METHODS A clinical investigation of 5 nonconsecutive patients with unilateral glaucoma treated daily with topical bimatoprost 0.03% for up to 4 years prior to presentation. RESULTS In eyes treated with bimatoprost 0.03% the authors noted periorbital fat atrophy, deepening of the upper eyelid sulcus, relative enophthalmos, loss of the lower eyelid fullness, and involution of dermatochalasis compared with the fellow untreated eye. By inspecting old photographs the authors confirmed that these unilateral changes were not present prior to starting bimatoprost. In addition, these changes were partially reversible after discontinuation of the medication, whenever that was possible. In 2 cases imaging studies confirmed the clinical impression that these findings were not related to primary orbital pathology. CONCLUSIONS Physicians and patients should be aware of the potential of bimatoprost 0.03% to produce periorbital changes.
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Results of Conjunctiva-Muller Muscle Resection in Mild Eyelid Ptosis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.9.1365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
PURPOSE To assess the predictability of the algorithm used to determine the amount of tissue resection for conjunctival-Müellerectomy during blepharoptosis repair. METHODS A consecutive case series of all patients undergoing conjunctival-Müellerectomy during blepharoptosis repair between July 2001 and February 2005. All of the cases had a positive phenylephrine test, and the mean preoperative upper marginal reflex distance (MRD1) was +1.60 mm (range: -1 +/-3.5 mm). Each patient underwent excision according to the following algorithm: 10 mm of resection for 2 mm of ptosis, 8 mm of resection for 1.5 mm of ptosis, and 6 mm of resection for 1 mm of ptosis. RESULTS Fifty-five patients underwent conjunctival-Müellerectomy during blepharoptosis repair on 73 eyelids, using the above algorithm. Thirty-seven cases were unilateral and 18 were bilateral. The mean postoperative MRD1 was +3.42 mm (range 0-+4.5 mm). Postoperative symmetry was found in 42 of 55 patients (76.4%) after one surgical procedure. Patient satisfaction based on contour, symmetry and height after one repair was achieved in 52 of 55 patients (94.55%). There were three reoperations for previous undercorrection. CONCLUSION This algorithm quantifies conjunctival-Müellerectomy during blepharoptosis repair. Excellent and very predictable results are obtained by a technique that is both simple and achievable in a short operating time.
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Postoperative complications in ophthalmic plastic and reconstructive surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.6.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Müller's Muscle–Conjunctival Resection for Correction of Upper Eyelid Ptosis. ACTA ACUST UNITED AC 2007; 9:413-7. [DOI: 10.1001/archfaci.9.6.413] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Müller Muscle-Conjunctiva Resection for Blepharoptosis in Patients With Glaucoma Filtering Blebs. Ophthalmic Plast Reconstr Surg 2007; 23:285-7. [PMID: 17667098 DOI: 10.1097/iop.0b013e318070d59d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the safety and efficacy of Müller muscle-conjunctiva resection (MMCR) for blepharoptosis in patients with functional glaucoma-filtering blebs. METHODS Retrospective chart review of patients who underwent MMCR in the presence of a functioning filtering bleb. Patients offered MMCR all responded satisfactorily to preoperative topical phenylephrine hydrochloride testing. Using a similar technique, MMCR was performed by 6 surgeons at 6 different centers. Two patients had simultaneous upper blepharoplasty. Postoperative slit lamp examination was performed to assess for bleb injury or infection. In addition, all patients had routine glaucoma follow-up visits to assess for bleb functioning. RESULTS Nine patients with functional filtering blebs tolerated MMCR well and had no bleb complications. All blebs remained functional after surgery. One patient had anterior chamber reaction for 10 days and another patient had foreign body sensation for 6 weeks. At 9.2-months mean follow-up time, the mean change in margin reflex distance-1 was 2.9 mm. CONCLUSION MMCR may be safe and effective in the setting of a glaucoma-filtering bleb.
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External levator advancement vs Müller's muscle-conjunctival resection for correction of upper eyelid involutional ptosis. Am J Ophthalmol 2005; 140:426-32. [PMID: 16083839 DOI: 10.1016/j.ajo.2005.03.033] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 03/09/2005] [Accepted: 03/10/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare external levator advancement and Müller's muscle-conjunctival resection (conjunctivomullerectomy, or CJM) for correction of upper eyelid involutional ptosis. DESIGN Retrospective, nonrandomized, comparative interventional case series. METHODS Review of medical records of 159 patients (272 surgical procedures) who underwent external levator advancement or CJM was performed. MAIN OUTCOME MEASURES Functional and cosmetic outcome, marginal reflex distance one (MRD1), and surgical complications. RESULTS A total of 159 patients (51 men, 108 women, mean age 70 years) underwent 272 surgical procedures for upper eyelid ptosis; concurrent blepharoplasty was performed in 141 cases. MRD1 increased an average of 1.6 (+/-1.5) mm, from 0.8 mm (+/-1.2) preoperatively to 2.3 mm (+/-1.2) postoperatively (P < .001). Fifteen patients (5.5%) underwent reoperation for residual ptosis, nine (18%) in the external levator advancement group, two (3%) in the CJM group, three (8%) in the external plus blepharoplasty group, and one (1%) in the CJM plus blepharoplasty group (P < .001). Patients who underwent external levator advancement had significantly more severe ptosis preoperatively but attained similar eyelid position postoperatively as compared with CJM patients. Complications included overcorrection in four cases (1.4%), lagophthalmos of 1 mm in 10 (3.6%), and pyogenic granuloma in two (<1%). CONCLUSIONS External levator advancement and CJM performed alone or with concurrent blepharoplasty are effective treatments for upper eyelid ptosis. Residual ptosis or postoperative eyelid retraction occurs in up to 20% of cases and can be addressed successfully with a second operation.
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Open Sky M??ller Muscle-Conjunctival Resection in Phenylephrine Test-Negative Blepharoptosis Patients. Ophthalmic Plast Reconstr Surg 2005; 21:276-80. [PMID: 16052140 DOI: 10.1097/01.iop.0000167789.39570.3e] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the efficacy of Müller muscle-conjunctival resection in patients in whom the phenylephrine test was negative. METHODS A non-randomized, prospective clinical trial was conducted on 20 eyelids of 15 consecutive patients with blepharoptosis who showed no change in the upper eyelid margin-reflex distance (MRD1) following instillation of topical phenylephrine. The technique used was open sky Müller muscle-conjunctival resection. RESULTS The mean MRD1 increased by 3.3 mm. No patient required augmentation of the procedure, and all patients had excellent appearance of their skin crease and eyelid contour. No complications arose from the procedure, including no incidence of dry eye symptoms or signs. CONCLUSIONS Müller muscle-conjunctival resection may offer a safe and effective means of treating blepharoptosis despite a negative phenylephrine test.
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Abstract
PURPOSE We describe a surgical technique for ptosis correction in moderate to good levator function involving resection of Müller's muscle of the upper eyelid. This is a substantial modification of the technique described by Putterman. We then present our experience of and the results from this method. METHODS A subtotal resection of Müller's muscle plus underlying conjunctiva is performed under direct visualisation. The muscle stump is reattached to the tarsus and the sutures passed through to the skin crease. In those cases where the phenylephrine test was positive to a level less than the desired lid height, a 1 mm of strip of tarsus is included in the tissue resection. The sutures are removed between 5 days and 3 weeks postoperatively allowing control over lid height and contour. A total of 61 eyes of 48 patients underwent this procedure. RESULTS Of 61 eyelids, 56 undergoing this procedure were within 0.5 mm of the desired end point, giving a success rate of 92%. Of 61 eyelids, 60 were within 1 mm of the desired height. Preoperative phenylephrine 10% was highly predictive of postoperative lid height (58/61). An excellent lid contour was noted in all cases (61/61). CONCLUSIONS We present a new approach to ptosis correction using Müller's muscle. It has a high success rate and good cosmetic outcome. It is technically straightforward and easy to learn.
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