Ptosis repair: external levator advancement vs. Muüller’s muscle-conjunctiva resection - techniques and modifications

Laplant, Jacquelyn; Kang, Julia; Cockerham, Kimberly P.

doi:10.20517/2347-9264.2020.69

Cited by 3 publications

(5 citation statements)

References 54 publications

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“…The mean surgical duration was 20,4 ± 3,9 min. (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) in the MMCR group and 44,9 ± 8,6 min. in the LA group.…”

Section: Resultsmentioning

confidence: 87%

“…Although it is possible to remove excess skin in MMCR, the external approach allows the removal of excessive skin and fat from the same incision if needed. Disadvantages of the LA include a steeper learning curve, longer surgical times compared to MMCR, less predictability, and increased risk of complications such as over/ under correction and abnormal lid contour [21][22][23][24]. MMCR efficacy on moderate and severe ptosis with or without respect to a phenylephrine response has been a subject of debate.…”

Section: Discussionmentioning

confidence: 99%

“…But, the effect of MMCR on correcting mild to moderate ptosis is not clear [ 4 , 8 , 9 ]. On the other hand, LA is among the most commonly performed external repairs used today [ 10 , 11 ]. The aim of our study was to evaluate the surgical outcomes of both MMCR and LA in the treatment of mild to moderate ptosis in cases with isolated congenital and aponeurotic blepharoptosis.…”

Section: Introductionmentioning

confidence: 99%

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The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis

2023

rjo

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Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis. Methods: A retrospective review of patients who underwent surgery for mild to moderate ptosis between 2015 and 2020 was performed. The degree of ptosis was graded based on the amount of upper eyelid drooping: mild ≤ 2 mm and moderate < 4 mm. Surgical success was defined as post-operative marginal reflex distance 1 (MRD1) ≥ 4.0 and ≤ 5.0 mm, and a satisfactory eyelid contour. Results: A total of 82 eyes of 65 patients underwent ptosis repair surgeries. MMCR was performed in 48 eyes and LA in 34 eyes. Under-correction was detected in 8.3% and 11.8% of the patients in MMCR group and LA group respectively. There was no patient with over-correction in the MMCR group postoperatively, 3 patients in the LA group had over-correction (0% vs. 8.8% respectively). The success rate in our study was found to be 91.7% in the MMCR group and 72.2% in the LA group. Conclusions: The MMCR and LA procedures are effective approaches in treating patients with mild to moderate eyelid ptosis in our population. Each procedure had its superiority in selected groups of patients. However, the complication rate and duration of surgery were found to be lower in MMCR group. Abbreviations: LA = Levator Advancement, LF = Levator Function, MMCR = Muller Muscle Conjunctival Resection, MRD 1 = Marginal Reflex Distance

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“…The mean surgical duration was 20,4 ± 3,9 min. (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) in the MMCR group and 44,9 ± 8,6 min. in the LA group.…”

Section: Resultsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis

2023

rjo

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“…[7][8][9] Patients with prediabetes have been shown to have significantly higher rates of ptosis when compared with those with no glucose intolerance status. 3 There is also a known association between obesity and increased rates of ptosis in which increased BMI values are correlated with decreased marginal reflex distance values. 4 Our data showed a significant difference in mean BMI of the OSA and non-OSA groups; higher BMIs were also significantly correlated with lower preoperative MRDs.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Management of ptosis primarily involves surgical correction, with external levator advancement or internal repair by Müller muscle-conjunctival resection (MMCR) the most common techniques used today. 3,4 Failure to improve the position of the eyelid after ptosis repair may necessitate a secondary procedure, with overall revision rates reported to be around 10%. 5,6 Recent investigations have demonstrated an association between involutional ptosis and various systemic conditions, such as obesity, hyperlipidemia, and type II diabetes mellitus.…”

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confidence: 99%

Obstructive Sleep Apnea Associated With Increased Failure Rate of Ptosis Repair

Nirmalan,

Tran,

Tailor

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: This study investigates how Obstructive sleep apnea (OSA) affects the outcomes of ptosis repair. We hypothesized that patients with OSA have an increased rate of reoperation after ptosis repair. Methods: This retrospective cohort study included patients age >18 from the Mayo Clinic who underwent ptosis repair by levator advancement or Müller muscle-conjunctiva resection between 2018 and 2021. Outcomes were measured at 1 to 3 months of follow-up with surgical failure defined as asymmetry or unsatisfactory eyelid height requiring revision surgery within 1 year. Results: A total of 577 patients met the inclusion criteria. There was a statistically significant difference in surgical failure between patients with OSA and those without (20.5% vs. 13.1%, p = 0.02). Patients with OSA showed a statistically significant difference in risk of revision by a factor of 1.70 (95% CI: 1.06–2.07). Revisions were attributed to unsatisfactory eyelid height in 72.6% of patients and eyelid asymmetry in 21.1%. All patients who had revision surgery had satisfactory outcomes. On logistic regression analysis, when adjusting for age and sex, OSA was significantly associated with ptosis revision (p = 0.007). Conclusions: OSA increases risk of surgical failure and need for revision surgery in patients undergoing blepharoptosis repair but is not a sole risk factor.

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Semi-adjustable posterior approach for congenital ptosis repair- outcomes of local and general anesthesia

Ben Ishai,

Ben Artsi,

Shouchane-Blum

et al. 2024

European Journal of Ophthalmology

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Background To report a single center experience with semi-adjustable posterior approach levator plication (‘levatorpexy’) in patients with congenital ptosis. Materials and methods A retrospective study. All cases who underwent posterior approach levatorpexy for congenital ptosis between the years 2016 to 2022 were included. The primary outcome measures were margin-to-reflex distance 1 (MRD1) before and after surgery, upper eyelid contour, symmetry of upper eyelid height, complications, and surgical success. Surgery was successful if all the following criteria were met: A postoperative MRD1 of ≥2 mm and ≤4.5 mm, a satisfactory eyelid contour in the operated eyelid, and an inter-eyelid MRD1 asymmetry of ≤1 mm. Postoperative modifications in semi-adjustable techniques were considered in all cases. Results Twenty-three eyelids of 21 patients were included, 11 were performed under general anesthesia, and 12 were performed under local anesthesia. The mean age of all patients was 24.1 years (8–47 years). The mean levator function was 11.2 (±2.11). Mean preoperative MRD1 was 1.05 mm and 1.41 for general and local anesthesia, respectively. Mean postoperative MRD1 was 3.33 mm and 3.37 mm for general and local anesthesia, respectively. Eighteen patients (85%) achieved the desired eyelid height and fulfilled our criteria for success. There were no complications reported in any of the groups. Conclusion Posterior approach levatorpexy is a safe and effective procedure for repairing congenital ptosis in patients with good levator function. This technique is suitable for young patients and those unable to undergo surgery under local anesthesia. This technique offers post-operative modification due to its semi-adjustable nature.

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Ptosis repair: external levator advancement vs. Muüller’s muscle-conjunctiva resection - techniques and modifications

Cited by 3 publications

References 54 publications

The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis

The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis

Obstructive Sleep Apnea Associated With Increased Failure Rate of Ptosis Repair

Semi-adjustable posterior approach for congenital ptosis repair- outcomes of local and general anesthesia

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