Dan Joshua, Sinha Kunal R, Rootman Daniel B
Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, University of California, Los Angeles, California, U.S.A.
Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, California, U.S.A.
Ophthalmic Plast Reconstr Surg. 2018 Sep/Oct;34(5):483-486. doi: 10.1097/IOP.0000000000001065.
This study aims to describe Müller's muscle-conjunctival resection surgery in terms of outcomes and potential factors that may predict final positions.
This cross-sectional cohort study included patients undergoing Müller's muscle-conjunctival resection surgery for involutional ptosis over a 15-year period. Success was defined in 2 ways: 1) final marginal reflex distance 1 (MRD1) ≥2.5 mm (MRD1 success) and 2) final difference in MRD1 ≤1 mm between eyelids (symmetry success). Percentages of patients achieving both outcomes were calculated. Predictors of outcome were assessed using bivariate analysis and multivariate models.
The final sample included 315 eyes in 192 patients. The mean age (standard deviation) was 67.9 (11.9) years, and 60.0% were female. MRD1 ≥2.5 mm was achieved in 65.7% of the sample. Symmetry within 1 mm was achieved in 82.9% of the sample. Significant (p < 0.05) predictors of MRD1 success were female sex, concurrent lower eyelid blepharoplasty, and higher preoperative MRD1 in bivariate analysis; preoperative MRD1 and female sex in the multivariate model; and preoperative MRD1 in the a priori model. Significant (p < 0.05) predictors of symmetry success were female sex, previous lower eyelid blepharoplasty, concurrent lateral canthoplasty, preoperative symmetry, and older age in bivariate analysis; only female sex in the multivariate model.
Müller's muscle-conjunctival resection is effective for elevating the eyelid in ptosis and may be more effective for achieving symmetry than absolute elevation over 2.5 mm. The results remain difficult to predict based clinical, surgical, or demographic factors.
本研究旨在描述米勒肌-结膜切除术的手术效果以及可能预测最终位置的潜在因素。
这项横断面队列研究纳入了在15年期间接受米勒肌-结膜切除术治疗老年性上睑下垂的患者。成功的定义有两种：1）最终边缘反射距离1（MRD1）≥2.5毫米（MRD1成功）；2）眼睑之间MRD1的最终差异≤1毫米（对称成功）。计算达到这两种结果的患者百分比。使用双变量分析和多变量模型评估结果的预测因素。
最终样本包括192例患者的315只眼。平均年龄（标准差）为67.9（11.9）岁，60.0%为女性。样本中65.7%的患者MRD1≥2.5毫米。样本中82.9%的患者实现了1毫米以内的对称。在双变量分析中，MRD1成功的显著（p<0.05）预测因素为女性、同期下睑成形术和术前较高的MRD1；在多变量模型中为术前MRD1和女性；在先验模型中为术前MRD1。在双变量分析中，对称成功的显著（p<0.05）预测因素为女性、既往下睑成形术、同期外眦成形术、术前对称性和年龄较大；在多变量模型中仅为女性。
米勒肌-结膜切除术在治疗上睑下垂时可有效提升上睑，并且在实现对称性方面可能比绝对提升超过2.5毫米更有效。基于临床、手术或人口统计学因素，结果仍然难以预测。
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