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Mechels KB, Hwang CJ, Perry JD. Conjunctival Müllerectomy With or Without Tarsectomy Using Absorbable Versus Nonabsorbable Suture. Ophthalmic Plast Reconstr Surg 2023; 39:386-388. [PMID: 36804359 DOI: 10.1097/iop.0000000000002334] [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: 02/23/2023]
Abstract
PURPOSE To compare the outcomes of blepharoptosis repair using conjunctival Müllerectomy with or without tarsectomy (CM±T) using absorbable suture versus nonabsorbable suture. METHODS Retrospective case-series of all consecutive cases of CM±T ptosis repair between January 1, 2019, and August 31, 2021. Patients were placed in groups based on whether they had absorbable or nonabsorbable suture used during their procedure. Preoperative and postoperative measurements of MRD1 were gathered in both groups, and information on patient satisfaction, symmetry, complications, and reoperations. RESULTS Ninety-two patients had surgery using nonabsorbable suture and 96 patients had surgery using absorbable suture, with average age of 72.0 and 70.9 years, respectively ( p = 0.488). When comparing nonabsorbable to absorbable suture, the groups did not differ on average preoperative MRD1 (1.11 mm [±0.96] vs. 0.96 mm [±0.86]; p = 0.161), average postoperative MRD1 (3.18 mm [±0.54] vs. 3.20 mm (±0.51); p = 0.736) or average MRD1 improvement (2.09 mm (±0.86) vs. 2.25 mm (±0.79); p = 0.089). Goal MRD1 was achieved in 85.3% of nonabsorbable cases and 82.8% of absorbable cases ( p = 0.562) and the rate of reoperation between groups was not significant ( p = 0.63). Good postoperative symmetry was noted in 91.6% of nonabsorbable and 91.0% absorbable suture cases ( p = 0.83). No difference in the number of complications was noted between groups ( p = 0.88), including need for contact lens placement (2.7% nonabsorbable, 1.3% absorbable; p = 0.37). CONCLUSIONS The use of absorbable suture was found to have predictable and effective outcomes similar to cases using nonabsorbable suture for CM±T without an increase in complications or rate or reoperation.
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Affiliation(s)
- Keegan B Mechels
- Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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van Philips IOR, van Minderhout HM, Stefanovic M, van Philips LAM. 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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Affiliation(s)
| | - Helena M van Minderhout
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Maja Stefanovic
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Lucien A M van Philips
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Haaglanden Medisch Centrum, The Hague, The Netherlands
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Lussier C, Leung VC, El-Khazen Dupuis J, Ashraf DC, Idowu OO, Massicotte E, Vagefi MR, Kersten RC, Kalin-Hajdu E. Prevalence and Predictors of Hering's Response in Müller's Muscle-conjunctival Resection. Ophthalmic Plast Reconstr Surg 2023; 39:237-242. [PMID: 36700873 DOI: 10.1097/iop.0000000000002297] [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: 01/27/2023]
Abstract
PURPOSE Determine the prevalence and predictors of Hering's response following Muller's muscle-conjunctival resection (MMCR). METHODS Seventy-five consecutive patients undergoing unilateral MMCR were recruited in this prospective, multicenter, cohort study. Margin-reflex distance-1 (MRD1) of both eyelids was recorded preoperatively and postoperatively. One hundred forty-three variables were investigated as potential predictors of a late postoperative (≥3 months) Hering's response using regression analyses. Main outcome measures were Hering's response (≥0.5 mm descent of the unoperated eyelid from baseline), and a clinically relevant Hering's response (descent of the unoperated from baseline to a MRD1 ≤ 2.0 mm, or descent from baseline such that the MRD1 of the unoperated eyelid became >1 mm lower than the operated eyelid). RESULTS Twenty-four (32.0%) patients had a late postoperative Hering's response, but only 6 (8.0%) responses were clinically relevant. A Hering's response at the immediate (OR 16.24, p = 0.02) and 1-week postoperative (OR 8.94, p = 0.04) timepoints predicted a late postoperative response. However, the presence (OR 7.84, p = 0.07) and amplitude (OR 8.13, p = 0.06) of a preoperative phenylephrine Hering's response did not predict a late postoperative response. Of the 10 patients with a clinically relevant phenylephrine Hering's response, only 1 demonstrated a clinically relevant response late postoperatively. CONCLUSION Unilateral MMCR induces a clinically relevant Hering's response in 8% of patients. A preoperative phenylephrine Hering's response does not predict a late postoperative Hering's response. Therefore, when unilateral phenylephrine testing unmasks contralateral blepharoptosis, only the side with blepharoptosis at baseline should be operated.
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Affiliation(s)
- Charlotte Lussier
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Victoria C Leung
- Department of Ophthalmology, William Osler Health System, Brampton, Ontario, Canada
| | | | - Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Erika Massicotte
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Leung VC, Dupuis JEK, Ashraf DC, Idowu OO, Massicotte E, Vagefi MR, Kersten RC, Kalin-Hajdu E. 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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Affiliation(s)
- Victoria C Leung
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | | | - Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Erika Massicotte
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
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Roelofs KA, Margines JB, Chen T, Goodyear K, Goldberg RA, Rootman DB. 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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Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
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Cohen LM, Rootman DB. 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: 3] [Impact Index Per Article: 1.0] [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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Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California Los Angeles, Los Angeles, 300 Stein Plaza, Los Angeles, CA 90095, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California Los Angeles, Los Angeles, 300 Stein Plaza, Los Angeles, CA 90095, USA.
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Yeh SH, Liao SL, Wei YH. 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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Affiliation(s)
- So-Hung Yeh
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, 12F, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, 12F, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei, Taiwan.
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Mangan MS, Tekcan H, Yurttaser Ocak S. Efficacy of Bandage Contact Lenses versus Eye Patching in Early Postoperative Period of Müller's Muscle-Conjunctival Resection. Ophthalmic Res 2020; 64:139-144. [PMID: 33091917 DOI: 10.1159/000512470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Patients with blepharoptosis who are treated with Müller's muscle-conjunctival resection (MMCR) may experience postoperative pain and discomfort related to the suture material on the palpebral conjunctiva. This study aims to compare the postoperative subjective complaints, such as pain and discomfort, with a visual analog scale (VAS), and objectively evaluate the cornea with a tear break-up time (TBUT) test and fluorescein staining following MMCR that was managed by either a bandage contact lens (BCL) or eye patching. METHODS Forty patients who had undergone a unilateral MMCR were randomized into 2 groups. Group 1 (n = 20) received a BCL, and group 2 (n = 20) received an eye patch following the MMCR. Patients were evaluated postoperatively at 1 and 7 days in this prospective study. The postoperative pain was measured using a VAS, and the requirement for anti-inflammatory medication was analyzed. A slit-lamp examination was performed to evaluate the cornea with a TBUT test and fluorescein staining by objectively using the National Eye Institute (NEI) classification. RESULTS BCL treatment decreased the VAS score, the need for anti-inflammatory medications, and fluorescein staining using the NEI score and increased the TBUT score significantly compared with the eye patch treatment (p < 0.001). CONCLUSIONS Our findings suggest that the use of a BCL may be beneficial in terms of reducing early postoperative pain and eye stinging, protecting the cornea, and retaining the ability to perform daily activities following a MMCR.
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Affiliation(s)
- Mehmet Serhat Mangan
- Division of Ophthalmic Plastic and Reconstructive Surgery, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic, University of Health Sciences, Istanbul, Turkey,
| | - Hatice Tekcan
- Division of Ophthalmic Plastic and Reconstructive Surgery, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic, University of Health Sciences, Istanbul, Turkey
| | - Serap Yurttaser Ocak
- Department of Ophthalmology, Okmeydani Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Abstract
PURPOSE Müller's muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Müller's muscle and conjunctiva, followed by suturing of the conjunctiva and Müller's muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures. METHODS The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications. RESULTS Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0-3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ test). One patient who underwent unilateral surgery demonstrated a Herring's response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively. CONCLUSIONS The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.
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Re: "The Sutureless Mullerectomy". Ophthalmic Plast Reconstr Surg 2019; 35:631. [PMID: 31693633 DOI: 10.1097/iop.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paap MK, Silkiss RZ. Improvements in Muller’s Muscle Resection Through the Use of Tenotomy Scissors and Dissolvable Suture. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/0748806819885252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Muller’s muscle resection is a straightforward and effective surgical treatment for acquired blepharoptosis. The authors describe a novel modification of this procedure that reduces risk of corneal complications using dissolvable suture and tenotomy scissors in place of scalpel excision. In all, 122 consecutive adult patients with mild to moderate acquired eyelid ptosis treated with this modified technique were identified through chart review. In this cohort, all patients were satisfied with the result, none required reoperation, and none sustained postoperative complications. This technique modification maintains procedural efficacy and efficiency while improving patient comfort and decreasing the risk of inadvertently cutting a suture and inducing a corneal abrasion or incision dehiscence.
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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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Closed Posterior Levator Advancement in Severe Ptosis. Plast Reconstr Surg Glob Open 2018; 6:e1781. [PMID: 29922563 PMCID: PMC5999440 DOI: 10.1097/gox.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/20/2018] [Indexed: 11/25/2022]
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External Levator Advancement versus Müller Muscle–Conjunctival Resection for Aponeurotic Blepharoptosis. Plast Reconstr Surg 2018; 141:213e-219e. [DOI: 10.1097/prs.0000000000004063] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Golbert M, Pereira FJ, Garcia DM, Cruz AAV. Contour Symmetry of the Upper Eyelid Following Bilateral Conjunctival-Müller's Muscle Resection. Aesthet Surg J 2017; 37:269-275. [PMID: 28011464 DOI: 10.1093/asj/sjw242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Conjunctiva-Müller muscle resection (CMMR) is a simple, effective, and predictable procedure for internal treatment of ptosis. Objectives The authors determined contour symmetry of the upper eyelid following bilateral CMMR. Methods Thirty control participants (ie, without ptosis) and 44 patients with acquired bilateral blepharoptosis who underwent CMMR were evaluated in a prospective study. To assess symmetry of lid contour, distances from midpupil to the upper eyelid (ie, MPLDs) were determined radially at intervals of 15° (total, 180°) along the palpebral fissure, and MPLDs at each angle were compared for right and left eyes. Results For control participants, the mean marginal reflex distance (MRD1; ie, MPLD at 90°) ± standard error (SE) was 4.05 mm ± 0.75 mm, and small contour asymmetries (<10%) were measured for all angles. Medial (9.4% ± 4.7%) and lateral (8.1% ± 4.9 %) asymmetries were not significantly different for these participants. For patients with ptosis, the mean preoperative MRD1 was 2.56 ± 0.1 mm, and mean medial and lateral lid asymmetries (14.3% ± 8.4% and 16.7% ± 9.7%, respectively) were significantly higher than those of controls. Medial and lateral asymmetries correlated significantly with the extent of ptosis and were more pronounced laterally than medially. One month after CMMR, the lateral-medial discrepancy in lid asymmetry was resolved, and mean medial and lateral MPLDs (9.9% ± 7.5% and 8.5% ± 5.3%, respectively) were similar to those of controls. Conclusions For patients with involutional ptosis, CMMR enables elevation of the lid margin and correction of contour anomalies.
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Affiliation(s)
- Marcelo Golbert
- Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , São Paulo , Brazil
| | - Filipe Jose Pereira
- Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , São Paulo , Brazil
| | - Denny M Garcia
- Departamento de Farmacologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Antonio A V Cruz
- Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , São Paulo , Brazil
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18
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Russell DJ, Silkiss RZ. Improved Efficiency of Muller’s Muscle Resection Through the Use of Locking Forceps In Lieu of Traction Sutures. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0748806816663923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Muller’s muscle resection (MMR) surgery is effective for repair of eyelid ptosis. We describe an efficient modification to the MMR surgery, as described by Putterman, which uses locking 0.5-mm forceps, in place of retraction sutures, to retract the conjunctiva and Muller’s muscle while the ptosis clamp is applied. A chart review was performed to identify 100 consecutive patients starting from January 2015 who underwent the described technique of MMR. Primary end points were need for reoperation or complications. Pathologic specimens were reviewed for similarity between the standard approach using retraction sutures and the modified technique using locking forceps. All 100 patients had satisfactory surgical outcomes. There were no complications or reoperations needed. Pathologic analysis on tissue from the standard technique and modified technique was similar. The described technique is a technically easy, cost-effective, and logistically feasible modification that ptosis surgeons could adopt immediately.
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Affiliation(s)
- David J. Russell
- California Pacific Medical Center, San Francisco, USA
- University of California, San Francisco, USA
| | - Rona Z. Silkiss
- California Pacific Medical Center, San Francisco, USA
- University of California, San Francisco, USA
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19
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Abstract
The aim of this study was to predict the improvement of the marginal reflex distance (MRD1) in each blepharoptosis surgery.In PubMed and Scopus, the search terms 1. (blepharoptosis) AND 2. (surgery) AND 3. (levator OR outcome OR MRD OR function OR ptosis amount) were used and 1268 titles were found. Among them 28 papers were analyzed: Aponeurotic surgery (A-group, 8), Muller muscle resection (M-group, 10), Levator resection (L-group, 4), and Frontalis suspension (F-group, 6).The preop-MRD1 was greatest in L-group (1.7 ± 1.0 mm) followed by the A-group (1.3 ± 0.5 mm) and the M-group (1.3 ± 0.5 mm). The F-group had the lowest (-0.4 ± 0.7 mm). Age was oldest in the M-group (58.6 ± 11.9 years) followed by the A-group (42.4 ± 18.9 years) and the F-group (27.2 ± 17.9 years). The L-group was the youngest (18.9 ± 11.5 years). The mean improved amount of MRD1 (ΔL) was 2.15 ± 0.90 mm. The ΔL was different among the four operative methods. The F-group was greatest (2.4 ± 1.5 mm) followed by the A-group (2.3 ± 0.5 mm) and the M-group (2.0 ± 0.6 mm). The L-group had the least improved amount of MRD1 (1.8 ± 0.8 mm). There were significant differences between the groups (P < 0.05), except between the F-group and the A-group (P = 0.284). The mean follow-up period was 8.1 ± 7.0 months. In the 3 groups except A-group, the ΔL decreased in follow-up periods, with different degree of decrement. Only in A-group, ΔL increased slightly in follow-up periods. We think this is due to relatively well preserved levator function and short follow-up period (5.4 ± 3.3 months) of A-group patients.The results of this review can be used in choosing blepharoptosis correction methods.
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20
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Rootman DB, Karlin J, Moore G, Goldberg R. 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: 20] [Impact Index Per Article: 2.2] [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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Affiliation(s)
- Dan B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California , Los Angeles, California , USA and
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21
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Patel RM, Chuang AZ, Sartori J, Aakalu VK, Putterman AM, Setabutr P. 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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Affiliation(s)
- Rakesh M Patel
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago, Illinois , USA and
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22
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Honavar SG, Manjandavida FP. Recent Advances in Ophthalmic Plastic Surgery: Part 1-Eyelid. Asia Pac J Ophthalmol (Phila) 2013; 2:328-40. [PMID: 26107037 DOI: 10.1097/apo.0000000000000003] [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
PURPOSE The objective of this study was to provide an update of the current literature in ophthalmic and facial plastic surgery, specifically related to disorders of the eyelid. DESIGN This was a review of published literature from January 2012 to June 2013 METHODS: The authors conducted a PubMed literature search of English-language articles published between January 2012 and June 2013 using the following search terms: eyelid, congenital, acquired, infection, inflammation, trauma, tumor, ptosis, entropion, ectropion, lagophthalmos, botulinum toxin, fillers, blepharoplasty, and miscellaneous topics related to the disorders of the eyelid. The authors included original articles, review articles, and case reports with relevant new information that is of potential clinical use to a comprehensive ophthalmologist as well as to the subspecialist. RESULTS Current literature on the disorders of the eyelid is replete with useful clinical information of relevance to a practicing ophthalmologist. Major advances have been reported in understanding of the surgical anatomy and its applications, ptosis, entropion, ectropion, lagophthalmos, infection, inflammation, trauma, and tumors. CONCLUSIONS There seems to be tremendous excitement in revisiting the anatomy and pathology and modifying the management protocols and surgical procedures to achieve optimal results, as the subspecialty continues to advance at a brisk pace.
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Affiliation(s)
- Santosh G Honavar
- From the *Department of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Centre for Sight, Hyderabad, India; and †Department of OphthalmicPlastic Surgery, Orbit and Ocular Oncology, C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
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