Abstract
Purpose
To evaluate short- and long-term success rates on isolated subtotal Muller resection in over 300 cases of ptosis over a 10-year period.
Methods
Clinical records were retrospectively evaluated for aetiology and severity of ptosis, levator function, response to phenylephrine, pre- and postoperative margin reflex distance of the upper lid (MRD1), postoperative lid contour and symmetry, complications and follow-up duration. Main outcome measures: change in MRD1 and eyelid contour. Surgical success: postoperative MRD1 ≥2 and ≤4.5 mm, symmetry to within 1.0 mm and satisfactory contour. All patients were also sent patient satisfaction questionnaires, and invited to attend for a longer-term assessment of their surgical outcome.
Results
In total, 92 and 95% of 309 eyelids met all three criteria for success after an average follow-up of 4 and 47 months, respectively. Mean improvement in MRD1 was 2.56 mm. In all, 97% had postoperative MRD1 of ≥2 and ≤4.5 mm and over 99% had an excellent contour. Altogether, 95 and 89% were within 1.0 and 0.5 mm symmetry of the fellow eye, respectively. In total, 51% of eyelids continued to rise, 17% maintained the same initial postoperative height, and 32% dropped by 1 mm or less. In all, 92% felt that their initial postoperative eyelid height had been maintained. Only 2% required repeat surgery and minor complications occurred in 4%.
Conclusions
Isolated subtotal Muller’s resection is safe and effective for the repair of the majority of ptosis with moderate-to-good levator function. It results in a more predictable height, which is maintained over time, less frequent contour abnormalities, and lower re-operation rates compared with anterior levator advancement.
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Acknowledgements
We are indebted to Anna Williams who was involved in this study and assisted in data collection.
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Peter, N., Khooshabeh, R. Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome. Eye 27, 519–524 (2013). https://doi.org/10.1038/eye.2012.303
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DOI: https://doi.org/10.1038/eye.2012.303
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