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The Utility of Preoperative Phenylephrine Testing in Müller Muscle Conjunctival Resection Surgery for Involutional
Persiana S Saffari1,2, Liane O Dallalzadeh3, Don O Kikkawa3,4
1David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A.
Ophthalmic Plastic and Reconstructive Surgery
|January 3, 2025
Summary
Preoperative phenylephrine testing does not significantly predict eyelid elevation after Müller muscle conjunctival resection. Surgeons should reconsider its routine use in ptosis surgery.
Area of Science:
- Ophthalmology
- Oculoplastics
Background:
- Phenylephrine testing is traditionally used to predict outcomes for Müller muscle conjunctival resection.
- Involutional ptosis affects eyelid position and is often treated with this surgical technique.
Purpose of the Study:
- To determine if preoperative phenylephrine testing impacts postoperative eyelid position changes after Müller muscle conjunctival resection.
Main Methods:
- A multicenter cross-sectional cohort study of 270 eyelids with involutional ptosis.
- Comparison of outcomes between eyelids with and without preoperative phenylephrine testing.
- Primary outcome: postoperative marginal reflex distance 1 (MRD1); Secondary outcomes: change in MRD1, reoperation rate.
Main Results:
- No significant difference in postoperative MRD1 or change in MRD1 between groups (p > 0.05).
- Preoperative phenylephrine testing correctly predicted postoperative MRD1 within 1 mm in 60.2% of cases.
- No statistical significance found in levator function, resection length, or reoperation rates.
Conclusions:
- Preoperative phenylephrine testing does not significantly predict postoperative eyelid elevation.
- The utility of routine preoperative phenylephrine testing in Müller muscle conjunctival resection warrants reassessment by surgeons.
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