Single Central Suture Mueller Muscle Conjunctival Resection Without Phenylephrine Test: 6-Year Experience

Mueller muscle conjunctival resection (MMCR) is widely used for the management of involutional ptosis and various techniques have been described. The decision to pursue MMCR classically depends on preoperative phenylephrine test (PPT). In this study, the authors assess the outcomes of a revised single central suture MMCR (csMMCR) without PPT.

This is a retrospective review of patients with involutional ptosis undergoing csMMCR without PPT by a single surgeon (R.S.) between February 2017 and February 2023. Patients were excluded if they had alternate etiologies of ptosis, follow-up <3 months, prior eyelid trauma/surgery, levator function <12 mm, moderate/severe dry eye, poor/fair Bell phenomenon or orbicularis tone, lagophthalmos, or adjunctive concurrent procedures. Hering's response and margin reflex distance-1 (MRD1) were recorded preoperatively. Surgeries were performed with local anesthesia in a minor procedure room. Patients were seen at postoperative week 1, month 1, month 3, and thereafter. Outcome measures were MRD1 at postoperative month 3 (POM3), change in MRD1, eyelid symmetry, complications, and reoperation rate.

A total of 597 patients, with 985 ptotic eyelids, were included; 382 (64%) were women, with a mean age of 66 years; and 388 (65%) patients had bilateral repair. All patients demonstrated an improved eyelid position with a mean increase in MRD1 at POM3 of 2.72 mm. A total of 568 (95.1%) patients showed eyelid symmetry within 1 mm at POM3 ( p < 0.001). Reoperation rate for residual ptosis was 1.42% of eyelids. There were no complications. The mean follow-up was 5.3 months.

csMMCR is an effective method for involutional ptosis repair without PPT in patients with good levator function.