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Posterior approach technique in mild ptosis repair
Seontae Kim, MD, Longyu Jin, MD, Jiyoung Suh, MD, Heebae Ahn 
, MD, PhD
Department of Ophthalmology, Dong-A University College of Medicine, Busan, Rep. of Korea
Correspondence to :
Heebae Ahn, E-mail: hbahn@dau.ac.kr, ORCID: https://orcid.org/0000-0002-8996-402X
© Korean Society of Korean Cosmetic Surgery & Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The success rates of conjunctiva-Müller muscle resection vary in reports of previous studies, with 81% to 88.6% success rates having been reported in other countries. Few studies have reported on the surgical success rates of conjunctiva-Müller muscle resection in Korea compared to the number of reports on other methods of blepharoptosis repair. We therefore sought to determine the clinical efficacy and success rate of conjunctiva-Müller muscle resection in patients with mild blepharoptosis and identify the factors that affect the surgical success rate.
Objective: This study was performed to evaluate of the clinical efficacy and success rate of conjunctiva-Müller muscle resection (posterior approach technique) in patients with mild blepharoptosis and to identify the factors that affect its surgical success rate.
Methods: Surgeries were performed by one surgeon in 30 patients (35 eyes) and only when the marginal reflex distance 1 (MRD1) increased over 1 mm at 5 minutes after the administration of 0.25% phenylephrine eye drops. The MRD1, MRD2, Brow-pupil distance (BPD), and interpalpebral fissure (IPF) were measured pre-operatively, 1 month post-operatively, and at the final follow-up visit.
Results: The mean MRD1 increased significantly from 0.83±0.96 mm pre-operatively to 2.45±0.77 mm post-operatively (p=0.012). The mean IPF also increased significantly from 5.54±2.04 mm pre-operatively to 7.62±1.85 mm post-operatively (p=0.003). The mean BPD, however, did not change significantly (22.94±4.96 mm pre-operatively and 23.19±5.72 mm post-operatively, p=0.863). The post-operative MRD1 for the eye with blepharoptosis was less than 1 mm compared to that for the opposite eye.
Conclusion: Conjunctiva-Müller muscle resection is a safe and effective surgical method in patients with mild or moderate blepharoptosis with good levator palpebrae muscle function in which the post-operative results can be predicted on the basis of the amount of muscle resection.
Keywords: blepharoptosis, conjunctiva-Müller muscle, levator palpebrae muscle, MRD1, surgical success
- Escalas P. Ptosis treated by resection of the Muller muscle:analysis of a series of 51 patients. J Fr Ophtalmol 2006;29:908-15.
- Older JJ. Levator aponeurosis surgery for the correction of acquired ptosis. Analysis of 113 procedures. Ophthalmology 1983;90:1056-9.
- Fasanella RM, Servat J. Levator resection for minimal ptosis:another simplified operation. Arch Ophthalmol 1961;65:493-6.
- Putterman AM, Urist MJ. Müller muscle-conjunctiva resection. Technique for treatment of blepharoptosis. Arch Ophthalmol 1975;93:619-23.
- Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA. Muller’s muscle-conjunctival resection for correction of upper eyelid ptosis: relationship between phenylephrine testing and the amount of tissue resected with final eyelid position. Arch Facial Plast Surg 2007;9:413-7.
- Weinstein GS, Buerger GF Jr. Modification of the Müller’s muscle-conjunctival resection operation for blepharoptosis. Am J Ophthalmol 1982;93:647-51.
- Karesh JW, Putterman AM, Fett DR. Conjunctiva-Müller’s muscle excision to correct anophthalmic ptosis. Ophthalmology 1986;93:1068-71.
- Bae JS, Ha MS, Lee JY. Results of conjunctiva-Müller muscle resection in mild eyelid ptosis. J Korean Ophthalmol Soc 2008;49:1365-70.
- Ha SW, Lee JM, Jeung WJ, Ahn HB. Clinical effects of conjunctivaMüller muscle resection in anophthalmic ptosis. Korean J Ophthalmol 2007;21:65-9.
- Park DI, Ha SW, Lew H. Clinical outcomes of conjunctiva-Müller muscle resection and factors which affect success. J Korean Ophthalmol Soc 2011;52:1263-8.
- Michels KS, Vagefi MR, Steele E, Zwick OM, Torres JJ, Seiff SR, et al. Müller muscle-conjunctiva resection to correct ptosis in high-risk patients. Ophthalmic Plast Reconstr Surg 2007;23:363-6.
- Dresner SC. Further modifications of the Müller’s muscle-conjunctival resection procedure for blepharoptosis. Ophthalmic Plast Reconstr Surg 1991;7:114-22.
- Mercandetti M, Putterman AM, Cohen ME, Mirante JP, Cohen AJ. Internal levator advancement by Müller’s muscle-conjunctival resection: technique and review. Arch Facial Plast Surg 2001;3:104-10.
- Zauberman NA, Koval T, Kinori M, Matani A, Rosner M, Ben-Simon GJ. Müller’s muscle-conjunctival resection for upper eyelid ptosis: correlation between amount of resected tissue and outcome. Br J Ophthalmol 2013;97:408-11.
- Kim SY, Chung WS. Analysis of the causes of ptosis. J Korean Ophthalmol Soc 1995;36:1649-54.
- Starck WJ, Griffin JE Jr, Epker BN. Objective evaluation of the eyelids and eyebrows after blepharoplasty. J Oral Maxillofac Surg 1996;54:297-302.
- Frankel AS, Kamer FM. The effect of blepharoplasty on eyebrow position. Arch Otolaryngol Head Neck Surg 1997;123:393-6.
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Original Article
J Cosmet Med 2018; 2(1): 8-11
Published online June 30, 2018 https://doi.org/10.25056/JCM.2018.2.1.8
Copyright © Korean Society of Korean Cosmetic Surgery & Medicine.
Posterior approach technique in mild ptosis repair
Seontae Kim, MD, Longyu Jin, MD, Jiyoung Suh, MD, Heebae Ahn , MD, PhD
Department of Ophthalmology, Dong-A University College of Medicine, Busan, Rep. of Korea
Correspondence to:Heebae Ahn, E-mail: hbahn@dau.ac.kr, ORCID: https://orcid.org/0000-0002-8996-402X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The success rates of conjunctiva-Müller muscle resection vary in reports of previous studies, with 81% to 88.6% success rates having been reported in other countries. Few studies have reported on the surgical success rates of conjunctiva-Müller muscle resection in Korea compared to the number of reports on other methods of blepharoptosis repair. We therefore sought to determine the clinical efficacy and success rate of conjunctiva-Müller muscle resection in patients with mild blepharoptosis and identify the factors that affect the surgical success rate.
Objective: This study was performed to evaluate of the clinical efficacy and success rate of conjunctiva-Müller muscle resection (posterior approach technique) in patients with mild blepharoptosis and to identify the factors that affect its surgical success rate.
Methods: Surgeries were performed by one surgeon in 30 patients (35 eyes) and only when the marginal reflex distance 1 (MRD1) increased over 1 mm at 5 minutes after the administration of 0.25% phenylephrine eye drops. The MRD1, MRD2, Brow-pupil distance (BPD), and interpalpebral fissure (IPF) were measured pre-operatively, 1 month post-operatively, and at the final follow-up visit.
Results: The mean MRD1 increased significantly from 0.83±0.96 mm pre-operatively to 2.45±0.77 mm post-operatively (p=0.012). The mean IPF also increased significantly from 5.54±2.04 mm pre-operatively to 7.62±1.85 mm post-operatively (p=0.003). The mean BPD, however, did not change significantly (22.94±4.96 mm pre-operatively and 23.19±5.72 mm post-operatively, p=0.863). The post-operative MRD1 for the eye with blepharoptosis was less than 1 mm compared to that for the opposite eye.
Conclusion: Conjunctiva-Müller muscle resection is a safe and effective surgical method in patients with mild or moderate blepharoptosis with good levator palpebrae muscle function in which the post-operative results can be predicted on the basis of the amount of muscle resection.
Keywords: blepharoptosis, conjunctiva-Müller muscle, levator palpebrae muscle, MRD1, surgical success
References
- Escalas P. Ptosis treated by resection of the Muller muscle:analysis of a series of 51 patients. J Fr Ophtalmol 2006;29:908-15.
- Older JJ. Levator aponeurosis surgery for the correction of acquired ptosis. Analysis of 113 procedures. Ophthalmology 1983;90:1056-9.
- Fasanella RM, Servat J. Levator resection for minimal ptosis:another simplified operation. Arch Ophthalmol 1961;65:493-6.
- Putterman AM, Urist MJ. Müller muscle-conjunctiva resection. Technique for treatment of blepharoptosis. Arch Ophthalmol 1975;93:619-23.
- Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA. Muller’s muscle-conjunctival resection for correction of upper eyelid ptosis: relationship between phenylephrine testing and the amount of tissue resected with final eyelid position. Arch Facial Plast Surg 2007;9:413-7.
- Weinstein GS, Buerger GF Jr. Modification of the Müller’s muscle-conjunctival resection operation for blepharoptosis. Am J Ophthalmol 1982;93:647-51.
- Karesh JW, Putterman AM, Fett DR. Conjunctiva-Müller’s muscle excision to correct anophthalmic ptosis. Ophthalmology 1986;93:1068-71.
- Bae JS, Ha MS, Lee JY. Results of conjunctiva-Müller muscle resection in mild eyelid ptosis. J Korean Ophthalmol Soc 2008;49:1365-70.
- Ha SW, Lee JM, Jeung WJ, Ahn HB. Clinical effects of conjunctivaMüller muscle resection in anophthalmic ptosis. Korean J Ophthalmol 2007;21:65-9.
- Park DI, Ha SW, Lew H. Clinical outcomes of conjunctiva-Müller muscle resection and factors which affect success. J Korean Ophthalmol Soc 2011;52:1263-8.
- Michels KS, Vagefi MR, Steele E, Zwick OM, Torres JJ, Seiff SR, et al. Müller muscle-conjunctiva resection to correct ptosis in high-risk patients. Ophthalmic Plast Reconstr Surg 2007;23:363-6.
- Dresner SC. Further modifications of the Müller’s muscle-conjunctival resection procedure for blepharoptosis. Ophthalmic Plast Reconstr Surg 1991;7:114-22.
- Mercandetti M, Putterman AM, Cohen ME, Mirante JP, Cohen AJ. Internal levator advancement by Müller’s muscle-conjunctival resection: technique and review. Arch Facial Plast Surg 2001;3:104-10.
- Zauberman NA, Koval T, Kinori M, Matani A, Rosner M, Ben-Simon GJ. Müller’s muscle-conjunctival resection for upper eyelid ptosis: correlation between amount of resected tissue and outcome. Br J Ophthalmol 2013;97:408-11.
- Kim SY, Chung WS. Analysis of the causes of ptosis. J Korean Ophthalmol Soc 1995;36:1649-54.
- Starck WJ, Griffin JE Jr, Epker BN. Objective evaluation of the eyelids and eyebrows after blepharoplasty. J Oral Maxillofac Surg 1996;54:297-302.
- Frankel AS, Kamer FM. The effect of blepharoplasty on eyebrow position. Arch Otolaryngol Head Neck Surg 1997;123:393-6.
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