The Wonder of Sutureless Müllerectomy

Müller muscle-conjunctival resection (MMCR) is a possible treatment for some cases of ptosis. Corneal irritation or erosions are potential complications due to the use of sutures.

The aim of this study was to evaluate the efficacy and safety of sutureless MMCR as a treatment for moderate to severe ptosis, and to assess postoperative eyelid symmetry and surgical success rates.

A retrospective, single-center cohort study was performed. Patients with a positive response to phenylephrine 10% underwent sutureless MMCR performed by the same surgeon. Pre- and postoperative margin-reflex distance 1 (MRD1) measurements were collected at baseline, and at 1 and 8 weeks after surgery. Data were collected from the files of 147 patients (252 eyes) with moderate to severe ptosis (MRD1, 0-2 mm) who underwent sutureless MMCR between October 2019 and October 2023.

Surgical success (defined as a postoperative MRD1 of ≥3 mm or ±0.5 mm of the preoperative MRD1 after phenylephrine instillation) was achieved in 88.5% of cases, with a mean [standard deviation] MRD1 improvement of 1.61 [0.89] mm (P < .001). Symmetry (defined as ≤1 mm difference in MRD1 between eyes) was obtained in 93.3% of bilateral cases. There was no significant difference between preoperative MRD1 after phenylephrine and postoperative MRD1 at 8 weeks (P = .54). Female patients had higher surgical success rates (odds ratio, 2.22; 95% CI, 1.01-4.95, P = .047). Complications were minimal, with wound dehiscence occurring in 1.19% of cases. Statistical analysis, including univariable and multivariable regression, was performed to assess factors associated with surgical outcomes.

Sutureless MMCR demonstrated high success rates and postoperative symmetry, with low complication rates, supporting its efficacy as a reliable and minimally invasive procedure for the treatment of ptosis.