A simplified sutureless Müllerectomy for ptosis repair: a case series

Müller's muscle-conjunctival resection (MMCR) is a well-established posterior approach to correct mild to moderate ptosis. Traditional methods involve resection of a measured segment of Müller's muscle and conjunctiva, followed by the approximation of resected edges with sutures. In recent years, various sutureless MMCR techniques have been reported. Here, we describe and evaluate a modified sutureless approach that eliminates the need for specialized instruments.

A retrospective case series was conducted to evaluate outcomes of patients who underwent sutureless MMCR ptosis repair. All surgeries were performed by one surgeon. For the procedure itself, curved hemostats were used to delineate and clamp the measured amount of Müller's muscle and conjunctiva, which were then resected and cauterized. Surgical outcomes, including margin reflex distance (MRD1) improvement, symmetry, and complications, were analyzed.

A total of 105 eyelids from 66 adult patients who underwent sutureless MMCR were included in this study. Fifty eyelids (47.6%) underwent concurrent procedures such as blepharoplasty and internal browpexy. The mean increase in MRD1 was 3.31 mm in the entire cohort and 2.76 mm in the MMCR-alone cohort. Symmetry within 1 mm was achieved in 96% of bilateral cases. Post-operative complications were limited to foreign body sensation in five patients and pyogenic granuloma in one patient. One patient required revision with external ptosis repair.

The modified sutureless MMCR described here is a simple, effective, and safe technique for ptosis repair, either in isolation or with concomitant eyelid and brow procedures, providing excellent outcomes with minimal potential complications.