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Updated: May 9, 2025

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

Pelin Celiker1, Diane Wang2,3, Wenyu Deng2

  • 1Tschannen Eye Institute, University of California, Davis, Sacramento, California.

Ophthalmic Plastic and Reconstructive Surgery
|May 6, 2025
PubMed
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This study shows that a revised single central suture Mueller muscle conjunctival resection (csMMCR) effectively treats involutional ptosis without a preoperative phenylephrine test (PPT), achieving good eyelid symmetry and minimal reoperations.

Area of Science:

  • Ophthalmology
  • Oculoplastics
  • Surgical Techniques

Background:

  • Involutional ptosis is commonly managed with Mueller muscle conjunctival resection (MMCR).
  • The preoperative phenylephrine test (PPT) traditionally guides MMCR decisions.
  • Various MMCR techniques exist, necessitating outcome evaluation.

Purpose of the Study:

  • To evaluate the efficacy of a revised single central suture MMCR (csMMCR) for involutional ptosis, specifically without the use of PPT.
  • To assess outcomes including margin reflex distance-1 (MRD1), eyelid symmetry, and complication rates.

Main Methods:

  • Retrospective review of 597 patients (985 eyelids) undergoing csMMCR without PPT by a single surgeon.
  • Exclusion criteria included other ptosis etiologies, short follow-up, prior eyelid surgery, poor levator function, or significant dry eye.

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  • Outcomes measured were MRD1 at 3 months postoperatively, symmetry, complications, and reoperation rates.

    • Main Results:

    • A mean MRD1 increase of 2.72 mm was observed at 3 months postoperatively.
    • 95.1% of patients achieved eyelid symmetry within 1 mm (p < 0.001).
    • The reoperation rate for residual ptosis was 1.42%, with no reported complications.

    Conclusions:

    • The revised single central suture Mueller muscle conjunctival resection (csMMCR) is an effective surgical option for involutional ptosis.
    • This technique can be successfully performed without the need for a preoperative phenylephrine test (PPT) in select patients.
    • csMMCR offers good functional and aesthetic outcomes with a low reoperation rate for suitable candidates.