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Pediatric Sutureless Conjunctiva-Sparing Versus Traditional Müllerectomy: A Comparative Study
Liane O Dallalzadeh1, Sava V Novakovic2, Phillip A Tenzel1
1Department of Ophthalmology, Division of Oculoplastic and Orbital Surgery, University of Texas Southwestern Medical Center.
The Journal of Craniofacial Surgery
|July 10, 2026
Summary
Sutureless conjunctiva-sparing Müllerectomy (CSM) offers comparable eyelid elevation to Müller muscle-conjunctival resection (MMCR) in pediatric ptosis repair. This technique significantly reduces operative time, making it a safe and efficient alternative.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Ptosis, or drooping eyelid, affects children and can impact vision.
- Traditional Müller muscle-conjunctival resection (MMCR) is a common surgical approach.
- Sutureless conjunctiva-sparing Müllerectomy (CSM) is a newer technique aiming for improved efficiency.
Purpose of the Study:
- To compare the efficacy and safety of sutureless CSM versus MMCR for pediatric ptosis repair.
- To evaluate outcomes such as eyelid elevation, symmetry, operative time, and complications.
Main Methods:
- Retrospective comparative study of pediatric patients (<18 years) with mild ptosis and good levator function (≥10 mm).
- Patients underwent either sutureless CSM or MMCR.
- Primary outcomes: change in margin-reflex distance 1 (ΔMRD1) and postoperative symmetry. Secondary outcomes: operative time, complications, reoperation.
Main Results:
- Thirty-three eyelids were analyzed (13 CSM, 20 MMCR).
- Both techniques yielded similar mean ΔMRD1 (1.2 mm vs. 1.3 mm) and symmetry (0.7 mm vs. 0.8 mm).
- Sutureless CSM had a significantly shorter operative time (7.5 min vs. 13.5 min per eyelid; P=0.001), with comparable reoperation and complication rates.
Conclusions:
- Sutureless CSM provides comparable eyelid elevation and symmetry to MMCR in pediatric ptosis repair.
- The technique significantly reduces surgical time, indicating it's a safe and efficient alternative.
- This supports the adoption of sutureless CSM for pediatric ptosis surgery.
