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Single Suture Müeller Muscle Conjunctival Resection (ssMMCR)

A Modified Technique for Ptosis Repair

Ediriwickrema, Lilangi S. M.D.*; Geng, June M.D.†,‡,§,¶,‖; Nair, Archana A. M.D.*,#; Prendes, Mark M.D.†,‡,§,¶,‖; Gerber, Austin L. M.D.†,‡,§,¶; Yang, Patrick T. M.D.*; Liu, Catherine Y. M.D., Ph.D.*; Nunery, William R. M.D.†,‡,§,¶; Harold Lee, H.B. M.D.†,‡,§,¶; Kikkawa, Don O. M.D.*,**; Korn, Bobby S. M.D., Ph.D.***

Ophthalmic Plastic & Reconstructive Surgery: July/August 2019 - Volume 35 - Issue 4 - p 403–406
doi: 10.1097/IOP.0000000000001380
Surgical Techniques
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Purpose: To evaluate the efficacy in degree of ptosis correction achieved by single suture Müeller muscle conjunctival resection (ssMMCR) when compared with that of traditional MMCR.

Methods: A retrospective chart analysis of patients who underwent either ssMMCR or traditional MMCR at 2 institutions. Single suture MMCR was performed after using a ptosis clamp to imbricate conjunctiva and Müeller muscle. Margin-to-reflex distance 1 was measured pre- and postoperatively, and the change in margin-to-reflex distance 1 was analyzed for both groups. Patients were monitored in follow up for postoperative complications including lagophthalmos, corneal abrasions, and change in visual acuity. Statistical analysis was performed using the Microsoft Excel and Stata software programs.

Results: Twenty-seven and 30 patients underwent single suture and traditional MMCR, respectively. The ssMMCR and MMCR groups were followed postoperatively for approximately 4.2 and 9.7 months, respectively and the average margin-to-reflex distance 1 increased by 2.93 mm and 2.81 mm, respectively. Notably, there was no statistically significant difference in the means identified by t test. Of the 94 eyelid surgeries evaluated, 1 ssMMCR and 3 MMCR eyelids required further surgical revision for persistent ptosis, and 1 ssMMCR developed a transient corneal epithelial abrasion. Surgical revisions were rare with both procedures, and patient satisfaction was high.

Conclusions: Single suture MMCR is an efficient and effective method for ptosis repair. It results in comparable outcomes including elevation in margin-to-reflex distance 1, safety profile, and reoperation rates, when compared with traditional MMCR.

Single suture Müeller muscle conjunctival resection (MMCR) is an efficient and effective method for ptosis repair, and results in comparable results to that of traditional MMCR.

*Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California

Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana

Oculofacial Plastic and Orbital Surgery, Indianapolis, Indiana

§St. Vincent Hospital, Indianapolis, Indiana

Department of Ophthalmology and Visual Sciences, University of Louisville, Kentucky

Department of Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio

#Department of Ophthalmology, New York University Langone Health, New York City, New York

**Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California

Accepted for publication March 6, 2019.

Supported by the Bell Charitable Foundation, Rancho Santa Fe, California; Research to Prevent Blindness, New York, New York.

The authors have no financial or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.op-rs.com.).

Presented at the Fall 2018 ASOPRS Meeting Video Presentation.

Co-Corresponding Authors: Address correspondence and reprint requests to Bobby S. Korn, M.D., Ph.D, Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA 92093. E-mail: bkorn@ucsd.edu, Address correspondence and reprint requests to HB Harold Lee, M.D. Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202. E-mail: huibae@gmail.com

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.