Isolated Muller's muscle resection for the correction of blepharoptosis

Abstract

Purpose To assess the outcome of isolated Muller's muscle resection with preservation of conjunctiva in patients with blepharoptosis and good to moderate levator function. Methods This study was designed as a prospective, nonrandomised case series. Thirty-four eyes of 27 blepharoptosis patients were operated on, who were phenylephrine test-negative as well as positive. Open-sky Muller's muscle resection was performed with preservation of the conjunctiva. Main outcome measures were increase in margin reflex distance (MRD1), eyelid contour, and symptoms and signs of dry eye. Results The mean increase in MRD1 was 2.75 mm. All but one patient (96%) had upper lid margins resting at or up to 1 mm below the limbus and obtained symmetry to within 0.5 mm of the fellow eye. No patients had symptoms or signs of dry eye. Conclusion Isolated Muller's muscle resection is effective for the correction of ptosis in patients with moderate to good levator function. This is irrespective of the lid's response to phenylephrine. Preservation of conjunctival tissue eliminates concerns about dry eye, and also preserves the full height of the fornix.

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

“…Modifications have since been described in order to better address Muller's muscle, including our open-sky technique, which engages Muller's muscle in a more direct approach, 11 and more recently, an isolated Muller resection to avoid sacrificing healthy conjunctiva. 12 We have also recently demonstrated its efficacy in patients with a negative phenylephrine response. 13 We herein report our results on isolated subtotal Muller resection in over 300 cases of both phenylephrine-positive and -negative ptosis repair over a 10-year period, including long-term data on 83 eyelids.…”

Minimal incision posterior approach levator plication for aponeurotic ptosis

“…[24][25][26][27] Peter et al, 24 in a large retrospective cohort of over 300 patients who were followed from 4-47 months, reported over 90% of cases met the success criteria. Most of the eyelids (96%) with severe ptosis of MRDo1 mm also achieved target lid height.…”

“…This technique was also found to be effective in phenylephrine-negative patients, because its success did not rely on the amount of Muller's muscle resected but rather from the consequent advancement of the levator. 24,26,27 However, 6% required augmentation of a subtotal Muller resection by either a small tarsectomy or conversion to posterior approach levator resection as described by Collin. 3,24 None of the eyelids in our study required augmentation surgery.…”

“…Although there is insufficient evidence on the aftermath of conjunctival excision, it is still desirable to conserve healthy conjunctival tissue to minimize the risk of dry eye symptoms and to prevent shallowing of the upper fornix, which is also of concern to anophthalmic patients who needed ptosis correction. 27 Recent techniques of posterior approach ptosis repair were modified to prevent excising any conjunctival tissue. [4][5][6][7]24,27 Regarding to the open sky mullectomy, Peter et al 24 reported that 4% of eyelids developed complications related to postoperative surface drying and presence of sutures on the palpebral conjunctiva, including corneal abrasions, suture abscesses, prolonged postoperative pain, and blood cyst.…”

“…27 Recent techniques of posterior approach ptosis repair were modified to prevent excising any conjunctival tissue. [4][5][6][7]24,27 Regarding to the open sky mullectomy, Peter et al 24 reported that 4% of eyelids developed complications related to postoperative surface drying and presence of sutures on the palpebral conjunctiva, including corneal abrasions, suture abscesses, prolonged postoperative pain, and blood cyst. We have not encountered any of these complications because our minimal incision technique does not require placing suture on the palpebral conjunctiva.…”