Abstract
Background
Both external levator resection (ELR) and Müller’s muscle-conjunctival resection (MMCR) are procedures well known to improve marginal reflex distance (MRD1) in patients with ptosis. This study aims to understand differential post-operative changes in eyelid contour for MMCR and ELR surgery.
Methods
In this cross-sectional cohort study, patients affected by involutional ptosis were randomized into two groups: those who underwent ELR or MMCR surgery. Pre-operative and late post-operative photographs were obtained. Digital analysis of the lid contour was performed by measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. Mean distance at each position was compared pre- and post-operatively between the groups.
Results
The final sample included 60 eyes from 39 patients, 30 eyes per group. At each time point there was significant variation in height across the eyelid (p < 0.05). A significant (p < 0.05) group difference in vertical height was noted only at the 2 and 4 mm temporal positions in the post-operative analysis, with the ELR group being slightly higher. There were no significant differences in MRD1, pre- or post-operatively, between the ELR and MMCR groups.
Conclusions
Both ELR and MMCR are effective at elevating the eyelid in multiple positions across the length of the eyelid. Although they do not produce significantly different MRD1 results, ELR was associated with a greater eyelid height at the 2 and 4 mm temporal positions.
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References
Dailey RA, Wobig JL. Eyelid anatomy. J Dermatol Surg Oncol. 1992;18:1023–7.
Small RG, Sabates NR, Burrows D. The measurement and definition of ptosis. Ophthal Plast Reconstr Surg. 1989;5:171–5.
Elner VM, Hassan AS, Frueh BR. Graded full-thickness anterior blepharotomy for upper eyelid retraction. Trans Am Ophthalmol Soc. 2003;101:67–73–5.
Morris CL, Morris WR, Fleming JC. A histological analysis of the Müllerectomy: redefining its mechanism in ptosis repair. Plast Reconstr Surg. 2011;127:2333–41.
Carter KD, Frueh BR, Hessburg TP, Musch DC. Long-term efficacy of orbital decompression for compressive optic neuropathy of Graves’ eye disease. Ophthalmology. 1991;98:1435–42.
Liu H, Shao Y, Zhang D. Surgical correction of blepharoptosis using a modified levator aponeurosis-Müller muscle complex reinsertion technique. J Craniofac Surg. 2014;25:226–30. http://www.ncbi.nlm.nih.gov/pubmed/24406583.
Melese M, Alemayehu W, Bejiga A, Adamu Y, Worku A. Modified grading system for upper eyelid trachomatous trichiasis. Ophthalmic Epidemiol. 2003;10:75–80.
Gower EW, West SK, Cassard SD, Munoz BE, Harding JC, Merbs SL. Definitions and standardization of a new grading scheme for eyelid contour abnormalities after trichiasis surgery. PLoS Negl Trop Dis. 2012;6:e1713.
Milbratz GH, Garcia DM, Guimares FC, Cruz AAV. Multiple radial mid pupil lid distances: a simple method for lid contour analysis. Ophthalmology. 2012;119:625–8.
Rüfer F, Schröder A, Erb C. White-to-white corneal diameter: normal values in healthy humans obtained with the Orbscan II topography system. Cornea. 2005;24:259–61.
Rootman DB, Karlin J, Moore G, Goldberg R. The role of tissue resection length in the determination of post-operative eyelid position for Muller’s muscle-conjunctival resection surgery. Orbit. 2015;34:92–8. http://www.tandfonline.com/doi/full/10.3109/01676830.2014.999096.
Cruz AAV, Coelho RP, Baccega A, Lucchezi MC, Souza ADA, Ruiz EES. Digital image processing measurement of the upper eyelid contour in graves disease and congenital blepharoptosis. Ophthalmology. 1998;105:913–8.
Cruz AA, Lucchezi MC. Quantification of palpebral fissure shape in severe congenital blepharoptosis. Ophthal Plast Reconstr Surg. 1999;15:232–5.
Simon GJB, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External levator advancement vs Müller’s muscle-conjunctival resection for correction of upper eyelid involutional ptosis. Am J Ophthalmol. 2005;140:426–32.
Cruz AA, Akaishi PM, Coelho RP. Quantitative comparison between upper eyelid retraction induced voluntarily and by Graves orbitopathy. Ophthal Plast Reconstr Surg. 2003;19:212–5. http://www.ncbi.nlm.nih.gov/pubmed/12918557.
Cruz AAV, Akaishi PMS, Mendonça AKTS, Bernadini F, Devoto M, Garcia DM. Supramaximal levator resection for unilateral congenital ptosis. Ophthal Plast Reconstr Surg. 2014;30:366–71. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002341-201409000-00002.
Ribeiro SFT, Milbratz GH, Garcia DM, Devoto M, Guilherme Neto H, Mörschbächer R, et al. Pre- and postoperative quantitative analysis of contour abnormalities in Graves upper eyelid retraction. Ophthal Plast Reconstr Surg. 2012;28:429–33. http://www.ncbi.nlm.nih.gov/pubmed/23138202.
Ribeiro SFT, Milbratz GH, Garcia DM, Fernandes VL, Rocha-Sousa A, Falcão-Reis FM, et al. Lateral and medial upper eyelid contour abnormalities in Graves orbitopathy. Ophthalmic Plast Reconstr Surg. 2013;29:40–3. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002341-201301000-00010%5Cnpapers2://publication/doi/10.1097/IOP.0b013e3182747537.
Ahn S, Lee H, Lee J, Park J, Park M, Baek S. Analysis of surgical outcome after levator advancement by assessing changes in eyelid contour. J Craniofac Surg. 2016;27:1147–50. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00001665-201607000-00009.
Malbouisson JM, Baccega A, Cruz AA. The geometrical basis of the eyelid contour. Ophthal Plast Reconstr Surg. 2000;16:427–31. http://www.ncbi.nlm.nih.gov/pubmed/11106186.
Flynn TH, Rose GE, Shah-Desai SD. Digital image analysis to characterize the upper lid marginal peak after levator aponeurosis repair. Ophthal Plast Reconstr Surg. 2011;27:12–4. http://www.ncbi.nlm.nih.gov/pubmed/20940664.
Kakizaki H, Zako M, Ide A, Mito H, Nakano T, Iwaki M. Causes of undercorrection of medial palpebral fissures in blepharoptosis surgery. Ophthalmic Plast Reconstr Surg. 2004;20:198–201. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002341-200405000-00004.
Lee H, Lee JS, Chang M, Park M, Baek S. Analysis of lid contour change with aging in Asians by measuring mid pupil lid distance. Plast Reconstr Surg. 2014;134:521e–9e. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006534-201410000-00008.
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This work was presented at the 2016 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO).
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Danesh, J., Ugradar, S., Goldberg, R. et al. A novel technique for the measurement of eyelid contour to compare outcomes following Muller’s muscle-conjunctival resection and external levator resection surgery. Eye 32, 1493–1497 (2018). https://doi.org/10.1038/s41433-018-0105-4
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DOI: https://doi.org/10.1038/s41433-018-0105-4
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