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

Abstract

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.

Symmetry of upper eyelid after unilateral blepharoptosis repair with minimally invasive conjoint fascial sheath suspension technique

“…To analyze eyelid symmetry based on MRD1, TPS, and BFS measurements, the asymmetry value delta was used, calculated using the following formula. The R and L stand for the measurements from the right and left sides [1] .…”

“…P atients with unilateral mild and moderate ptosis usually require surgical treatment of the unaesthetic eyelid. There are three viable options basically: Muller's muscleconjunctival resection (MMCR) [1][2] , the Fasanella-Servat procedure and levator aponeurosis repair [3] . Traditionally surgery for aponeurotic ptosis has been directed upon the levator aponeurosis complex, in the majority of cases, through an anterior approach.…”