Müller Muscle Conjunctival Resection: A Multicentered Prospective Analysis of Surgical Success

Leung, Victoria; Dupuis, Jessica El-Khazen; Ashraf, Davin C.; Idowu, Oluwatobi O; Massicotte, Erika; Vagefi, M. Reza; Kersten, Robert C.; Kalin-Hajdu, Evan

doi:10.1097/iop.0000000000002292

Cited by 11 publications

(4 citation statements)

References 32 publications

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“…Authors of some studies hypothesize that phenylephrine administration simulates the postoperative result and propose a resection algorithm based on the phenylephrine response. 13 , 18 , 24 , 25 , 28 , 29 , 33 In contrast, other studies have obtained excellent results after performing mullerectomy in eyelids that were unresponsive to phenylephrine 12 , 27 or in patients with Horner syndrome. 14 In a recent prospective study by Lueng et al, the MRD1 measured after fenyl drops did not predict postoperative success, in contrast to the prefenyl MRD1, which was the only significant predicting factor for success.…”

Section: Discussionmentioning

confidence: 93%

“… 14 In a recent prospective study by Lueng et al, the MRD1 measured after fenyl drops did not predict postoperative success, in contrast to the prefenyl MRD1, which was the only significant predicting factor for success. 33 In our opinion, the preoperative phenylephrine administration test to determine whether the patient with eyelid ptosis is a candidate for the MMCR procedure and to estimate resection margins can be omitted. The success of the MMCR procedure is likely not determined by the exact amount of muscle resection, but more likely by general posterior lamellar shortening resulting in a levator aponeurosis plication (either shortening or reinserting onto the tarsus) 26 , 34 , 35 ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

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Posterior Müller Muscle-Conjunctival Resection as a First Step to Treat Eyelid Ptosis: Clinical Results and Treatment Algorithm

Fechner,

Kappen,

van Rooij

et al. 2024

Aesthetic Surgery Journal Open Forum

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Background The posterior Müller muscle-conjunctival resection (MMCR) procedure is a straightforward procedure for the correction of eyelid ptosis with a relatively short operating time and fast recovery. Traditionally, its use was limited to patients with mild involutional ptosis and good levator function and a positive phenylephrine test result. Objectives To evaluate the efficacy of the MMCR procedure as a primary step to treat eyelid ptosis with varying etiology and severity, including patients with more severe ptosis and moderate levator function, and to produce a treatment algorithm. Methods A retrospective analysis of the results of 34 patients, comprising 56 operated eyelids, treated with the MMCR procedure for eyelid ptotis between 2016 and 2018, was performed. Preoperative and postoperative pictures were analyzed for determining the margin-to-reflex distance (MRD1), symmetry, and complications. Results We found a mean preoperative MRD1 of 1.3 mm (SD 1.1) and postoperative MRD1 of 3.2 mm (SD 1.0). The mean postoperative MRD1 for unilateral and bilateral cases was 3.4 (SD 0.8) and 3.2 (SD 1.1), respectively. Only 2 patients (5.9%) had an asymmetrical postoperative result (>1.0 mm MRD1 difference), and both were unilateral cases. Complications were scarce: only 1 patient (2.9%) developed dry eyes and 2 patients experienced temporary discomfort from the conjunctival sutures. Conclusions The MMCR procedure appears to be an excellent procedure as a primary step to correct eyelid ptosis with varying etiologies and severity, due to its low risk of asymmetry, short learning curve, and high success rate. A flow chart as treatment algorithm is provided for clinical decision making. Level of Evidence: 4

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Posterior Müller Muscle-Conjunctival Resection as a First Step to Treat Eyelid Ptosis: Clinical Results and Treatment Algorithm

Fechner,

Kappen,

van Rooij

et al. 2024

Aesthetic Surgery Journal Open Forum

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“…There are studies conducted to evaluate the MMCR surgery outcome, however, the MRD1 analyze method was not mentioned. For example, Leung et al has conducted a multicenter prospective study and evaluated the effect of 2.5% phenylephrine test, amount of the response to the phenylephrine test and excised MMC tissue on the surgical success rate of the MMCR surgery, however, the measurement method was not stated in the paper (18). Similarly, Dryden et al reported the results of the levator-Muller tissue complex resection (the technique described by Morris et al) surgery for ptosis repair by measuring the MRD1 and stated that, in cases who responded to the phenylephrine test can benefit from the 8 mm and 10 mm resection of the levator-Muller tissue complex, however, the authors did not mention about the MRD1 measurement method in the paper (7).…”

Section: Discussionmentioning

confidence: 99%

Müller kası rezeksiyon cerrahisi: Objektif ve yeni bir method ile cerrahi başarının değerlendirilmesi

YOLCU,

YAYLACİOGLU TUNCAY

2024

Osmangazi̇ Journal of Medicine

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Amaç: Çalışmanın amacı, 6mm veya 8mm eksizyonla gerçekleştirilen Müller kası konjonktival rezeksiyon (MMCR) cerrahisi sonrası oto-refraktometrenin (AR) ön monitör görüntülerini (FMI) kullanarak üst göz kapağı pozisyonundaki değişiklikleri değerlendirmektir. Yöntem: Ocak 2020-Nisan 2023 tarihleri arasında 6mm veya 8mm MMCR cerrahisi uygulanan hastaların tıbbi kayıtları geriye dönük olarak incelendi. Üst göz kapağı yüksekliği (Margin reflex distance: MRD1) AR-FMI ve Image J yazılımı kullanılarak değerlendirildi. Cerrahi öncesi ve sonrası takiplerde alınan AR-FMI’ler incelenerek üst göz kapağı pozisyonu (AR-MRD1) belirlendi. Bulgular: Çalışmaya dahil edilen 34 kişiden 14'üne 6mm, 20'sine ise 8mm MMCR cerrahisi uygulandı. Cerrahi öncesi ortalama AR-MRD1 değeri 6mm MMCR grubu için 2,1 0,8 mm; 8mm MMCR grubu için 2,30,7 mm idi ve gruplar arasında anlamlı fark yoktu (p:0,45). Cerrahi sonrası AR-MRD1 6mm rezeksiyon grubunda 8mm rezeksiyon grubuna göre daha yüksekti ancak fark anlamlı değildi (6mm MMCR grubu için 3,90,5 mm ve 8mm MMCR grubu için 3,60,7 mm idi) (p:0,14). Ortalama AR-MRD1 farkı 6mm rezeksiyon grubunda 1,4  0,2 mm ve 8 mm rezeksiyon grubunda 1,10,3 mm idi ancak fark anlamlı değildi (p.0,09). Sonuç: MMCR cerrahi başarısını etkileyen faktörler incelenmektedir ve daha güvenilir sonuçlar elde etmek için daha objektif ve standartlaştırılmış MRD ölçüm yöntemine ihtiyaç vardır. Mevcut çalışma sonuçlarına göre 6mm veya 8mm MMCR ameliyatı ile benzer göz kapağı yüksekliği elde etmek mümkün olup, kolay değerlendirilebilen ve uygun maliyetli bir cihaz kullanılarak cerrahi sonucu analiz etmek mümkündür.

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“…The first group comprised subjects who underwent ELA and the second group were patients who underwent MMCR for the management of involutional eyelid ptosis with levator function greater than 10 mm. Unilateral ptosis was defined as MRD1 ≤2.0 mm and more than a 1 mm difference in MRD1 between two eyelids (14) .…”

Section: Methodsmentioning

confidence: 99%

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

Bilici,

Harbigil-Sever,

Ugurbas

2024

ABO

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Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Müller's muscle conjunctival resection surgery in unilateral ptosis. Methods: We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Müller's muscle conjunctival resection. Eyelid contour analysis was conducted on preoperative and 6-month postoperative digital images. This was performed with the multiple margin reflex distances technique, measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. The marginal peak point changes were analyzed digitally using the coordinates of the peak point according to the pupil center. Each position's mean distance was compared preoperatively, postoperatively, and with the fellow eyelid. Results: Sixteen patients underwent external levator advancement and 16 patients had Müller's muscle conjunctival resection. The mean margin reflex distance was improved by both techniques (1.46 vs. 2.43 mm and 1.12 vs. 2.25 mm, p=0.008 and p=0.0001 respectively) and approached that of the fellow eyelid (2.43 vs. 2.88 and 2.25 vs. 2.58 mm, p=0.23 and p=0.19, respectively). However, statistically significant lid margin elevation was limited to between the N6 and T6 points in the external levator advancement group. Whereas, significant elevation was achieved along the whole lid margin in the Müller's muscle conjunctival resection group. The marginal peak point was shifted slightly laterally in the external levator advancement group (p=0.11). Conclusions: Both techniques provide effective lid elevation, however, the external levator advancement's effect lessens toward the canthi while Müller's muscle conjunctival resection provides more uniform elevation across the lid margin. The margin reflex distance alone is not sufficient to reflect contour changes.

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Müller Muscle Conjunctival Resection: A Multicentered Prospective Analysis of Surgical Success

Cited by 11 publications

References 32 publications

Posterior Müller Muscle-Conjunctival Resection as a First Step to Treat Eyelid Ptosis: Clinical Results and Treatment Algorithm

Posterior Müller Muscle-Conjunctival Resection as a First Step to Treat Eyelid Ptosis: Clinical Results and Treatment Algorithm

Müller kası rezeksiyon cerrahisi: Objektif ve yeni bir method ile cerrahi başarının değerlendirilmesi

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

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