Mullers Muscle Conjunctival Resection for Treatment of Contact Lens-Associated Ptosis

Teo, Livia; Lagler, Christine P; Mannor, Geva; Glass, Lora Dagi; Freitag, Suzanne K.

doi:10.1097/iop.0000000000000479

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…Our success rate in correcting aponeurotic ptosis compares favorably with previously published, algorithmic approaches to ptosis surgery. Algorithms are a common feature of Müller muscle conjunctival resection surgery, with studies reporting success rates generally exceeding 80% . Although the success rate of our technique is similar to previous algorithmic approaches, direct comparison of studies is difficult because the definition of success varies in the literature .…”

Section: Discussionmentioning

confidence: 84%

“…Algorithms are a common feature of Müller muscle conjunctival resection surgery, with studies reporting success rates generally exceeding 80%. [4][5][6][7]19,20 Although the success rate of our technique is similar to previous algorithmic approaches, direct comparison of studies is difficult because the definition of success varies in the literature. 21 Our definition of success allowed us to investigate the efficacy and the predictability of our technique by comparing the postoperative MRD1 with the goal MRD1 in external ptosis repair.…”

Section: Discussionmentioning

confidence: 99%

“…An advantage of the internal technique is that this approach generally does not require intraoperative adjustments, relying instead on algorithms . The archetypical internal ptosis surgery is the Müller muscle conjunctival resection; it is best suited to ptosis of mild to moderate severity .…”

Section: Introductionmentioning

confidence: 99%

“…An advantage of the internal technique is that this approach generally does not require intraoperative adjustments, relying instead on algorithms. [4][5][6][7] The archetypical internal ptosis surgery is the Müller muscle conjunctival resection; it is best suited to ptosis of mild to moderate severity. 8 Broader ranges of ptosis severity can be addressed by external approaches, but these techniques require intraoperative eyelid height adjustments without algorithms for guidance.…”

mentioning

confidence: 99%

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Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Repp¹,

Rubinstein²,

Sires³

2017

JAMA Facial Plast Surg

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IMPORTANCE External surgical treatment of involutional ptosis with normal levator function is challenging owing to lack of an established algorithm. Developing an algorithm-based technique could improve postoperative results while limiting intraoperative inefficiencies. OBJECTIVE To investigate the postoperative success of an algorithmic external levator aponeurosis resection technique for aponeurotic ptosis with good levator function. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients with involutional ptosis and normal levator function who were treated from July 1, 2015, through November 30, 2016, at a private ophthalmic plastic surgery clinic. INTERVENTIONSThe technique involved a small incision in the eyelid crease, with dissection through the orbital septum to expose the levator aponeurosis. The leading edge of the aponeurosis was then clamped to a medical-grade spring scale to standardize the stress on the eyelid between patients. Two millimeters of aponeurosis were resected for every 1 mm of desired ptosis correction. Two sutures were then placed to connect the aponeurosis to the tarsus at predetermined locations. MAIN OUTCOMES AND MEASURES Preoperative predicted (goal) vs actual margin reflex distance-1 (MRD1).RESULTS Twenty-six eyelids of 15 patients (6 men and 9 women; mean [SD] age, 65 years [range, 17-84 years]) met inclusion criteria. The mean follow-up was 189 days (range, 63-343 days). The mean preoperative MRD1 was 0.44 mm (range, −0.5 to 2 mm; 95% CI, 0.18-0.70 mm) compared with the final mean MRD1 of 3.2 mm (range, 2.5-4.0 mm; 95% CI, 3.1-3.4 mm; P < .001). The mean predicted goal MRD1 was 3.4 mm (range, 2.5-4.0 mm; 95% CI, 3.2-3.5 mm). The final MRD1 of all eyelids was within 1 mm of the goal MRD1. The mean surgical time per eyelid was 14.6 minutes (range, 10.5-34.0 minutes). Twelve eyelids (46%) did not have intraoperative suture adjustments. CONCLUSIONS AND RELEVANCEIn correcting aponeurotic ptosis, a small-incision levator aponeurectomy incorporating an algorithm and consistent stress on the aponeurosis during resection achieves the goal MRD1 efficiently. The algorithm closely estimates the desired height intraoperatively such that only small intraoperative suture height revisions, if any, are needed. No intraoperative adjustments were made in 12 eyelids, necessitating future studies to determine whether any adjustments are needed.LEVEL OF EVIDENCE 3.

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Section: Discussionmentioning

confidence: 84%