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

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.
• 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.