How far we have come: A review of the evolution of posterior approach ptosis surgery

Ullrich, Katja; Malhotra, Raman

doi:10.1111/ceo.13574

Cited by 9 publications

(9 citation statements)

References 47 publications

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“…MMCR was first described by Putterman and Urist in 1975 [1], and it has increased in its popularity due to its cosmetic improvement, fast recovery, lack of external scar, and simplicity. MMCR may have several surgical designs [2][3][4] and variable resection lengths, and some studies have compared the results of MMCR with or without tarsectomy [5][6][7]. In our previous surgical experience, MMCR alone without tarsectomy did not achieve satisfactory results in our Asian patients.…”

Section: Introductionmentioning

confidence: 68%

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Efficacy and predictability of Muller’s muscle-conjunctival resection with different tarsectomy lengths for unilateral blepharoptosis treatment

2021

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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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Section: Introductionmentioning

confidence: 68%

“…The resection amount depends on the response to phenylephrine testing. Since then, MMCR has come with a lot of modified surgical designs [2][3][4]. Later on, Perry et al defined a modified algorithm which included tarsectomy into his procedure [7].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and predictability of Muller’s muscle-conjunctival resection with different tarsectomy lengths for unilateral blepharoptosis treatment

2021

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“…MMCR was rst described by Putterman and Urist in 1975 (1), and it is gaining its popularity due to its cosmetic improvement, fast recovery, lack of external scar, and simplicity. MMCR may have several surgical designs (2)(3)(4) and variable resection lengths, and some studies have compared the results of MMCR with or without tarsectomy (5)(6)(7). In our previous surgical experience, MMCR alone without tarsectomy did not achieve satisfactory results in our Asian patients.…”

Section: Introductionmentioning

confidence: 68%

“…The resection amount depends on the response to phenylephrine testing. Since then, MMCR has come with a lot of modi ed surgical designs (2)(3)(4). Later on, Perry et al de ned a modi ed algorithm which included tarsectomy into his procedure (7).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Predictability of Muller's Muscle-conjunctival Resection with Different Tarsectomy Lengths for Unilateral Blepharoptosis Treatment

Yeh

Laio

Wei

2020

Preprint

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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 complications or overcorrections were noted.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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“…Az első feljegyzett, kötőhártya felől végzett ptosisműtét Sir William Bowman brit szemész nevéhez fűződik. 1857-ben veleszületett szemhéjcsüngés korrekciója céljából végzett transconjunctivalis levatorreszekciót és tarsectomiát [10,11]. A későbbiekben elterjedt, kötőhártya felől végzett, tarsectomiával kombinált levatorreszekció típusú ptosisműtétek "atyjának" Blaskovics Lászlót (1869-1938) tekinthetjük, műtéti technikáját 1923-ban közölte [7].…”

Section: Megbeszélésunclassified

Veleszületett szemhéjcsüngés műtéti megoldása a szemhéjemelő izom kötőhártya felőli redőzésével

Antus

Lukáts

Szalai

et al. 2021

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Összefoglaló. Bevezetés: Szemhéjcsüngésnek (ptosis vagy blepharoptosis) nevezzük azt az állapotot, amikor a felső szemhéj abnormálisan alacsony pozícióban van. A szemhéjcsüngésnek lehetnek veleszületett és szerzett formái. Célkitűzés: Célunk volt bemutatni a szemhéjemelő izom (levator) – veleszületett szemhéjcsüngés korrekciója céljából végzett – kötőhártya felőli redőzésének eredményeit retrospektív módszerrel. Módszer: 20 beteg 22 szemhéján végeztük el a műtétet (átlagéletkor: 19,4 ± 9,9 év, férfi: 12 [60%], nő: 8 [40%]). Beválasztási kritérium volt a közepes (5–8 mm) vagy jó (9 mm felett) levatorfunkció. Kizártuk a korábban szemhéjkorrekciós műtéten átesett és a 3 hónapnál rövidebb követési idővel rendelkező betegeket. A műtét előtt megmértük a levatorfunkciót és a margó–reflex-távolságot. A műtét után megmértük a margó–reflex-távolságot, a szemhéjak magassága közti aszimmetria mértékét, és elemeztük a szemhéj posztoperatív kontúrját. Eredmények: A preoperatív levatorfunkció 10,6 ± 3,0 mm, a preoperatív margó–reflex-távolság 1,8 ± 0,8 mm volt. A 7,8 ± 7,2 hónap átlagos követési idő alatt a posztoperatív margó–reflex-távolság 3,2 ± 0,8 mm volt. A preoperatív és a posztoperatív margó–reflex-távolság különbsége nem tért el szignifikánsan a sikeres és a sikertelen műtétek között (p = 0,523). A szemhéjak magassága közti aszimmetria mértéke 3 betegnél haladta meg az 1 mm-t. A szemhéj posztoperatív kontúrja minden esetben megfelelő volt. A műtét összességében 86,4%-ban (19/22) volt sikeres. A helyi érzéstelenítésben és altatásban végzett műtétek közt nem találtunk szignifikáns különbséget a sikeresség tekintetében (p = 0,227). Következtetés: Tanulmányunk alapján az elvégzett műtéteink eredményessége a nemzetközi irodalomban közöltekhez hasonló volt. A veleszületett szemhéjcsüngés korrekciójára a kötőhártya felőli levatorredőzés megfelelő kezelési mód közepes vagy annál jobb levatorfunkció esetén. Orv Hetil. 2021; 162(18): 705–711. Summary. Introduction: Droopy eyelid (ptosis or blepharoptosis) is defined through abnormally low upper eyelid position. Ptosis can be classified as congenital or acquired. Objective: Our purpose was to report the results of posterior approach levator plication for congenital ptosis in a retrospective review. Method: 22 eyelids of 20 patients were included in this study (age: 19.4 ± 9.9 years, male: 12 [60%], female: 8 [40%]). The inclusion criteria were moderate (5–8 mm) or good (more than 9 mm) levator function. Patients with postoperative follow-up time shorter than 3 months and those who underwent previous eyelid surgery were excluded. The data collected included preoperative levator function and margin reflex distance, postoperative margin reflex distance, inter-eyelid height asymmetry and postoperative eyelid contour. Results: Preoperative levator function was 10.6 ± 3.0 mm, preoperative margin reflex distance was 1.8 ± 0.8 mm. During 7.8 ± 7.2 months postoperative follow-up, postoperative margin reflex distance was 3.2 ± 0.8 mm. The difference between preoperative and postoperative margin reflex distance was not significant (p = 0.523) in the group of successful operations compared with unsuccessful operations. Inter-eyelid height asymmetry was more than 1 mm in 3 cases. Satisfactory postoperative eyelid contour was achieved in all cases. Overall success rate was 86.4% (19/22). Surgical success did not differ significantly between surgeries in local or general anaesthesia (p = 0.227). Conclusion: Our study shows an overall success rate of the procedures comparable to those in international publications. Posterior approach levator plication for congenital ptosis with moderate or better levator function seems to be a suitable treatment method. Orv Hetil. 2021; 162(18): 705–711.

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How far we have come: A review of the evolution of posterior approach ptosis surgery

Cited by 9 publications

References 47 publications

Efficacy and predictability of Muller’s muscle-conjunctival resection with different tarsectomy lengths for unilateral blepharoptosis treatment

Efficacy and predictability of Muller’s muscle-conjunctival resection with different tarsectomy lengths for unilateral blepharoptosis treatment

Efficacy and Predictability of Muller's Muscle-conjunctival Resection with Different Tarsectomy Lengths for Unilateral Blepharoptosis Treatment

Veleszületett szemhéjcsüngés műtéti megoldása a szemhéjemelő izom kötőhártya felőli redőzésével

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