Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Yitzhak Shamir Medical Center, Sackler School of Medicine, Tel Aviv University, Tzrifin, Israel.
Department of Ophthalmology, Kaplan Medical Center, Hebrew University Medical School, Rehovot, Israel.
Ophthalmic Plast Reconstr Surg. 2019 May/Jun;35(3):290-293. doi: 10.1097/IOP.0000000000001331.
Müller's muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Müller's muscle and conjunctiva, followed by suturing of the conjunctiva and Müller's muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures.
The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications.
Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0-3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ test). One patient who underwent unilateral surgery demonstrated a Herring's response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively.
The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.
Müller 肌-结膜切除术（MMCR）是一种著名的上睑下垂修复方法。在其标准形式中，它涉及 Müller 肌和结膜的切除，然后用可吸收或不可吸收缝线将结膜和 Müller 肌缝合到睑板上。作者在此介绍了他们在不使用缝线的情况下进行 MMCR 的经验。
本研究回顾性分析了 19 例（34 只眼）接受无缝线 MMCR 的患者。33 只眼为获得性上睑下垂，1 只眼为先天性上睑下垂。手术包括标准入路和放置 Putterman 夹。夹住组织切除后，不放置内部缝线。测量术前和术后上睑缘至反射距离，并评估患者 1mm 内的对称性和任何并发症的发生率。
19 例患者共进行 34 例无缝线 MMCR 手术。其中 13 例患者行双侧上睑下垂修复术。34 只眼（97%）中有 33 只眼的上睑缘至反射距离得到改善，所有患者的平均改善值为 1.4mm（范围，0-3.5mm，SD=0.64）。19 例患者中有 18 例（94.7%）术后上睑缘至反射距离的对称性在 1mm 以内（p<0.001，χ检验）。1 例单侧手术患者术后出现 Herring 反应，导致 1 例不对称。术后有 1 例角膜擦伤。
无缝线技术是一种快速有效的 MMCR 方法。该技术尤其适用于轻度上睑下垂的眼睑成形术，以达到额外的年轻化效果。与标准缝线技术相比，它风险低，对角膜有保护作用。进一步的研究可以确定是否需要应用改良的算法。
