Outcomes After Müller Muscle Conjunctival Resection Versus External Levator Advancement in Severe Involutional Blepharoptosis

Sweeney, Adam R.; Dermarkarian, Christopher R.; Williams, Katherine J.; Allen, Richard C.; Yen, Michael T.

doi:10.1016/j.ajo.2020.04.039

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…The number of studies comparing the clinical outcomes of ELA and MMCR in the literature is very limited and the few present were published in the recent years [4][5][6][7]. Similar to these studies, we also observed more successful clinical outcomes in MMCR.…”

Section: Discussionsupporting

confidence: 86%

“…External levator advancement (ELA) and Müller's muscle-conjunctival resection (MMCR) are the most common techniques used in the treatment of aponeurotic ptosis, yet the treatment of choice remains controversial [1][2][3][4][5][6][7][8]. Along with the severity of ptosis and response to phenylephrine test, surgeon's preference and experience may play a major role in the choice of surgical technique [1][2][3][4][5][6][7][8][9]. A questionnaire of members of the American Society of Ophthalmic and Reconstructive Surgery about blepharoptosis surgery reported that 74% of surgeons performed posterior approach ptosis surgery [9].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, studies with large patient series that compare the clinical outcomes of ELA and MMCR have been published [4][5][6][7]. These studies reported the outcomes of both bilateral and unilateral ptosis surgeries and there is no study that reports the outcomes of solely unilateral ptosis surgery.…”

Section: Introductionmentioning

confidence: 99%

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Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Mangan

Çakir

İmamoğlu

2021

Korean J Ophthalmol

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Purpose: Even though it is stated that external levator advancement (ELA) has a much longer learning curve than Müller muscle-conjunctival resection (MMCR) in the treatment of aponeurotic ptosis, there is no study in the literature regarding the learning curves of these two surgical techniques. We aimed to objectively determine the length of the learning curves of ELA and MMCR using cumulative sum (CUSUM) analysis.Methods: The first 30 unilateral ELA and the first 30 unilateral MMCR consecutively performed by a single surgeon were retrospectively reviewed. The CUSUM method was used to analyze the learning curves of ELA and MMCR based on operation times of consecutive surgeries and the clinical outcomes were compared.Results: CUSUM analyses revealed that the operation time stabilized after around 11 ELA surgeries and 12 MMCR surgeries and R2 value for ELA and MMCR were 0.93 and 0.91, respectively. There was no significant difference in these stratified analyses. Mean operation time was 45.7 minutes in the ELA group and 34.1 minutes in the MMCR group (p = 0.002). Total number of intraoperative complications was 37 in the ELA group and 16 in the MMCR group (p = 0.015). Symmetry success rate was significantly higher (p < 0.0001) and reoperation rate was significantly lower in the MMCR group (p = 0.045).Conclusions: Even though ELA is more challenging than MMCR, comparable learning curves indicate that surgeons in training need to be encouraged to perform both techniques. The challenges and obstacles that the surgeons in training face in these two techniques need to be analyzed in detail.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Mangan

Çakir

İmamoğlu

2021

Korean J Ophthalmol

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“…9 MMCR may still be applied to patients with severe ptosis either as it is or by way of some modifications. 10–13 Sweeney et al 14 demonstrated a statistically significant higher rate of success following MMCR compared to external levator resection in patients with severe ptosis. In a study by Dresner 15 there was a strong linear relationship between the amount of MMCR in mm and postoperative correction of eyelid level whereas in another study tissue resection length was not shown as a predictor of postoperative eyelid position.…”

Section: Introductionmentioning

confidence: 99%

Comparing the outcome of Muller’s muscle conjunctival resection for mild/moderate versus severe involutional aponeurotic ptosis

Nacaroğlu

Karabulut

Fazıl

et al. 2020

European Journal of Ophthalmology

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Aims: To compare predictability of the outcomes of Muller’s muscle conjunctiva resection (MMCR) in patients with severe versus mild/moderate involutional aponeurotic ptosis. Methods: This was a retrospective case-control study. All cases were recruited into the groups in terms of preoperative marginal reflex distance of upper eyelid (MRD-1). Group 1 consisted of patients with mild to moderate blepharoptosis was defined as an MRD-1 equal to 1.1 to 3 mm and Group 2 consisted of patients with severe blepharoptosis defined as MRD-1 ⩽ 1 mm. All patients underwent MMCR based on the response to phenylephrine and the amount of ptosis. MRD-1 obtained both manually and with ImageJ analysis program preoperatively and on the postoperative sixth month was compared. Successful surgical outcome criteria were defined as MRD-1 ⩾ 2.5 mm and inter-eyelid symmetry ⩽ 1 mm. Results: A total of 97 eyes of 83 participants met the inclusion criteria for this study (Group 1 n = 50, Group 2 n = 47). In terms of MRD-1 success rates were 88% in Group 1, and 70.2% in Group 2 ( p = 0.03). Preoperative MRD-1 which was measured by ImageJ, and the amount of resected tissue in mm were the predictive data of surgical outcome by the logistic regression analysis (OR 6.45, 95% CI 1.82–22.78, p = 0.004, OR 2.47, 95% CI 1.05–5.80, p = 0.037, respectively). Conclusion: The surgical success of MMCR can be predicted via tissue resection length and preoperative MRD-1. Higher surgical success rates were obtained in cases with mild-moderate ptosis and clinically acceptable success rates were obtained in cases with severe ptosis.

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“…Efficacy: The success rates of ptosis repair were not significantly different between study and control group (75% vs 84.1%, p = 0.19), and were in the range of ptosis repair outcomes reported in prior studies. 28,29 Interestingly, we found that a significantly larger proportion of patients in the glaucoma surgery group had severe ptosis at baseline (MRD1 ⩽ 0 mm) compared to control (44.9% vs 28.6%; p = 0.027). This finding suggests that the previously listed mechanisms may not only affect the incidence, but also the severity of ptosis after filtering surgery.…”

Section: Discussionmentioning

confidence: 75%

Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery

Song

Khanna

Jamali

et al. 2021

European Journal of Ophthalmology

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Purpose: There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery. Methods: A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery. Results: Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications. Conclusions: Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.

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Outcomes After Müller Muscle Conjunctival Resection Versus External Levator Advancement in Severe Involutional Blepharoptosis

Cited by 19 publications

References 25 publications

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Comparing the outcome of Muller’s muscle conjunctival resection for mild/moderate versus severe involutional aponeurotic ptosis

Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery

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