Various Modifications of Müller's Muscle-Conjunctival Resection for Ptosis Repair

Abstract

Background The posterior approach for ptosis, including the Fasanella-Servat procedure and Müller's muscle-conjunctival resection (MMCR), has been proven effective for mild-to moderately affected patients whose levator muscle function remains relatively intact. Traditionally, MMCR was reserved for phenylephrine test-positive patients for whom various modifications and several nomograms have been developed. Methods We reviewed the literature for the Fasanella-Servat procedure and MMCR. The methods and results of the different modifications were analyzed and compared. Nomograms of these two procedures were summarized. Results MMCR mainly involved resection of Müller's muscle and conjunctiva in the original design by Putterman and co-workers. The suggested resection ranged from 8 to 9 mm for the achievement of the maximal effect produced by topical epinephrine. Perry included tarsectomy in his procedure and developed a new nomogram that included a 1:1 ratio of the ptosis correction to the amount of tarsus resection. The effect of tarsectomy for the Fasanella-Servat procedure in terms of eyelid elevation was approximately one-half the value seen in phenylephrine test-negative patients. We've performed MMCR with tarsectomy regardless of the response to phenylephrine with similar results to Perry. Surgical indications and possible complications of MMCR with tarsectomy for Asian patients are discussed. Conclusions MMCR is an effective and simple method for the correction of ptosis. With baseline MMCR, the additional tarsectomy has proven to be a powerful tool for ptosis correction irrespective of phenylephrine test results.

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

“…The exact mechanism by which MMCR works for ptosis remains to be elucidated (5). As for the results of our study, the mechanism and e cacy of this surgical design can be discussed from two different perspectives: MMCR and tarsectomy.…”

“…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.…”

Müller’s Muscle-Conjunctival Resection for Treatment of Contralateral Ptosis Following Unilateral External Levator Advancement

“…In the present study of 26 cases, 24 (92.3%) had good or perfect upper eyelid height symmetry, and 47 of 52 eyelids (90.3%) had optimal upper eyelid height following MMCR, which is favorable to the findings of previous studies. [21][22][23][24][25][26][27] In this study, the achievement of a satisfactory result may be a consequence of using the phenylephrine test to predict the final contralateral eyelid position, whereas the amount of tissue to resect was determined based on the amount of ptosis correction after comparison of both eyelid heights. Although the MRD1 varies by different amounts with the phenylephrine test before MMCR, these findings may support the recommendation for using a previously described algorithm and technique 21 to achieve eyelid height symmetry after MMCR in most patients.…”

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

“…The exact mechanism by which MMCR works for ptosis remains to be elucidated [ 5 ]. As for the results of our study, the mechanism and efficacy of this surgical design can be discussed from two different perspectives: MMCR and tarsectomy.…”

“…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 – 4 ] and variable resection lengths, and some studies have compared the results of MMCR with or without tarsectomy [ 5 – 7 ]. In our previous surgical experience, MMCR alone without tarsectomy did not achieve satisfactory results in our Asian patients.…”