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Suture Traction Maneuver to Minimize Hemorrhage in Müller Muscle-Conjunctival Resection: One Minute Technique
Emirhan Ozkul1, Mehmet Serhat Mangan2
1Department of Ophthalmology, Sancaktepe Prof. Dr. Ilhan Varank Education and Research Hospital, University of Health Sciences.
Introduction:
Müller muscle-conjunctival resection (MMCR) is a widely adopted procedure for the correction of mild-to-moderate ptosis. Although technically straightforward and effective, intraoperative and postoperative hemorrhage remains a notable complication, particularly during the early learning curve. This study describes a simple traction-suture maneuver designed to minimize hemorrhage following MMCR.
Surgical Technique:
A retrospective review was performed of 23 patients (12 women, 11 men; mean age: 50.0±14.4 y) who underwent MMCR with the adjunctive traction-suture technique. Following conjunctiva-Müller muscle excision, a 6-0 polypropylene suture was gently tensioned for ∼1 minute to compress the resection bed before being tied over a bolster. A bandage contact lens was placed, and both the suture and lens were removed on postoperative day 10.
Results:
The mean amount of tissue resection was 8.4±0.6 mm, with a mean follow-up of 4.0±2.6 months. The average postoperative improvement in margin reflex distance 1 (MRD1) was 2.2 mm, with all patients achieving adequate eyelid elevation and complete clearance of the visual axis. No intraoperative or postoperative complications were observed, including hemorrhage, exposure keratopathy, or suture-related problems. None of the patients required revision surgery or experienced recurrence during follow-up.
Conclusions:
The addition of a 1-minute traction-suture step during MMCR may provide effective intraoperative tamponade, mitigating the risk of delayed hemorrhage without adding complexity to the procedure. This simple and reproducible maneuver represents a potential refinement to enhance the safety and predictability of MMCR.
Insights
A new traction-suture technique for Müller muscle-conjunctival resection (MMCR) effectively minimizes bleeding during ptosis surgery. This simple addition to MMCR enhances safety and predictability, reducing complication risks for patients.
Area of Science:
- Ophthalmology
- Oculoplastic Surgery
Background:
- Müller muscle-conjunctival resection (MMCR) is a standard procedure for ptosis correction.
- Hemorrhage is a known complication of MMCR, especially for surgeons new to the technique.
Purpose of the Study:
- To introduce and evaluate a novel traction-suture maneuver to reduce bleeding during MMCR.
- To assess the safety and efficacy of this technique in ptosis repair.
Main Methods:
- A retrospective review of 23 patients undergoing MMCR with an added traction-suture technique.
- A 6-0 polypropylene suture was applied for 1 minute to tamponade the resection bed post-excision.
- Patients were followed for an average of 4.0 months.
Main Results:
- All patients achieved adequate eyelid elevation (mean MRD1 improvement of 2.2 mm) with no visual axis obstruction.
- No intraoperative or postoperative complications, including hemorrhage, were reported.
- No patients required revision surgery or experienced recurrence.
Conclusions:
- The traction-suture maneuver provides effective tamponade, significantly reducing hemorrhage risk during MMCR.
- This simple, reproducible technique enhances the safety and predictability of ptosis surgery.
- The maneuver does not add complexity to the established MMCR procedure.
