Abstract
Aim: To evaluate results of transconjuncunctival muller’s muscle resection for congenital ptosis with phenylepherine test.
Methods: This was a prospective study carried out at a tertiary care center in Central India. All patients with mild to moderate congenital ptosis were enrolled and any patient with previous surgery and corneal pathologies were excluded. MRD1, MRD2, amount of ptosis, Levator palpebrae superioris action and effect of phenylephrine test was noted. Graded transconjuctival muller’s muscle resection was performed. Pre-operative and post-operative parameters were compared. Data tabulated and analysis done.
Results: In the present study, total 21 patients were included with age ranging from 7 years to 26 years. In 12 cases only right eye was involved and in 9 cases left eye was affected. Female preponderance was observed. Average amount of ptosis was 2mm, average amount of phenylephrine improvement was 1.52mm. Muller muscle resection was carried out as 6 mm in 8 cases, 8 mm in 11 cases and 10 mm in 2 cases, each respectively. Levator palpebral superioris muscle action was in range from 8 mm to 15 mm with average of 10 mm. None of the cases required resurgery.
Conclusion: The study concluded that muller’s muscle transconjunctival surgery is very predictable surgery for mild to moderate ptosis with good levator function. Phenylephrine test helps to decide the plan and increases the predictability.
References
- Smith B, McCord CD, Baylis H. Surgical treatment of blepharoptosis. Am J Ophthalmol. 1969:68:92–9. [PubMed]
- Sakol PJ, Mannor G, Massaro BM. Congenital and acquired blepharoptosis. Curr Opin Ophthalmol. 1999:10:335–9. [PubMed]
- Guercio JR, Martyn LJ. Congenital malformations of the eye and orbit. Otolaryngol Clin North Am. 2007:40:113–40. [PubMed]
- Langford JD, Linberg JV, Blaylock WK, Chao GM. Axial myopia in congenital ptosis: An animal model. Ophthal Plast Reconstr Surg. 1998:14:261–5. [PubMed]
- Kao SC, Tsai CC, Lee SM, Liu JH. Astigmatic change following congenital ptosis surgery. Zhonghua Yi XueZaZhi (Taipei) 1998:61:689–93. [PubMed]
- Langford JD,Linberg JV, Blaylock WK, Chao GM. Axial myopia in congenital ptosis: An animal model. Ophthal Plast Reconstr Surg.1998:14:261-5[PubMed]
- Putterman AM, Urist MJ. Mu¨ller’s muscle-conjunctival resection. Arch Ophthalmol. 1975:93(8):619-623.
- Guyuron B, Davies B. Experience with the modified Putterman procedure. Plast Reconstr Surg. 1988:82(5):775-780
- Putterman AM, Fett DR. Mu¨ller’s muscle in the treatment of upper eyelid ptosis: a ten-year study. Ophthalmic Surg. 1986:17(6):354-360.
- Weinstein GS, Buerger GF Jr. Modifications of the Mu¨ller’s muscle-conjunctival resection operation for blepharoptosis. Am J Ophthalmol. 1982:93(5):647-651
- Dresner SC. Further modifications of the Muller’s muscle-conjunctival resection procedure for blepharoptosis. Ophthal Plast Reconstr Surg. 1991:7(2):114-122.
- Perry JD, Kadakia A, Foster JA. A new algorithm for ptosis repair using conjunctival Mu¨llerectomy with or without tarsectomy. Ophthal Plast Reconstr Surg. 2002:18(6):426-429.
- Baldwin HC, Bhagey J, Khooshabeh R. Open sky Muller muscleconjunctival resection in phenylephrine test–negative blepharoptosis patients. Ophthal Plast Reconstr Surg. 2005:21(4):276-280.
- Morax S, Ben Ayed H, Pereira-Nunes T, Hamedani M. Advantages of a double approach to upper blepharoplasty associated with eyelid malpositions [in French]. J Fr Ophtalmol. 2003:26(9):993-997.
- Brown MS, Putterman AM. The effect of upper blepharoplasty on eyelid position when performed concomitantly with Muller muscle-conjunctival resection. Ophthal Plast Reconstr Surg. 2000:16(2):94-100.
Corresponding Author
Dr Minal Vyawahare
Ph no: 9881563456, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.142
