The Sutureless Mullerectomy

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, χ2 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.

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

“…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.…”

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

“…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.…”

“…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).…”

Efficacy of Bandage Contact Lenses versus Eye Patching in Early Postoperative Period of Müller’s Muscle-Conjunctival Resection

“…One alternative is a sutureless technique was reported by Lauring [6] in 1977. In recent years, sutureless technique has become popular again [11]. Additionally, Ediriwickrema et al [12] reported the single suture MMCR modification and Carruth and Meyer [13] reported the simplified MMCR technique.…”

“…Different surgical modalities have been reported that reduce the risk of wound closure-related complications [3-6, 11-13]. Kavanagh et al [4] reported that the MMCR ptosis repair using a fibrin sealant for wound closure is effective for postoperative pain and discomfort compared with sutures.…”