Opthalmic Plastic and Reconstructive Surgery Department, Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.
Ophthalmic Plast Reconstr Surg. 2020 Sep/Oct;36(5):458-462. doi: 10.1097/IOP.0000000000001594.
To evaluate surgical outcomes of Müller muscle conjunctival resection surgery for reoperation of residual ptosis after external levator advancement in patients with aponeurotic ptosis.
A total of 23 eyes of 23 patients who had undergone Müller muscle conjunctival resection for residual ptosis between January 2016 and July 2018 were reviewed retrospectively. Margin reflex distance (MRD), interlid crease, and show distance measurements were performed with a ruler in millimeters during the office examination, and the photographs of patients were taken before the procedure and on the 10th day, at the first, third, and sixth months after the procedure. The successful outcome was described as MRD1 between 3 and 5 mm, interlid MRD1 difference ≤1 mm, interlid crease difference ≤2 mm, interlid show difference ≤2 mm, and the presence of symmetrical lid contour.
The mean increases in MRD1 were statistically significant at the first, third, and sixth months postoperatively when compared with preoperative values both before external levator advancement and before Müller muscle conjunctival resection (p = 0.000). There was statistically significant decrease in interlid MRD1 difference, interlid crease difference, and interlid show difference relative to preoperative values. Interlid crease and show difference within the range of successful outcome criteria were achieved in all patients. However, interlid MRD1 difference exceeded 1 mm in only 1 patient who had overcorrection.
In patients who have residual ptosis without contour abnormality following external levator advancement, and positive response to phenylephrine testing, Müller muscle conjunctival resection is an effective approach.
评估 Müller 肌结膜切除术治疗腱膜性上睑下垂患者外直肌前徙术后残余上睑下垂的手术效果。
回顾性分析 2016 年 1 月至 2018 年 7 月因残余上睑下垂接受 Müller 肌结膜切除术的 23 例（23 只眼）患者的临床资料。采用直尺测量术野检查时的睑裂高度（MRD）、重睑皱襞、睑缘显露距离，并在术前、术后第 10 天及术后 1、3、6 个月拍摄患者照片。手术成功的标准为：MRD1 为 3~5mm，重睑皱襞高度差值≤1mm，重睑皱襞宽度差值≤2mm，睑缘显露距离差值≤2mm，且上睑外形对称。
与外直肌前徙术前及 Müller 肌结膜切除术术前相比，术后第 1、3、6 个月的 MRD1 均显著增加（p=0.000）。与术前相比，术后 1、3、6 个月的重睑皱襞高度差值、重睑皱襞宽度差值、睑缘显露距离差值均显著减小。所有患者的重睑皱襞高度差值、重睑皱襞宽度差值、睑缘显露距离差值均达到成功标准范围内。但有 1 例患者因过矫，重睑皱襞高度差值>1mm。
对于外直肌前徙术后出现残余上睑下垂但无形态异常、对苯肾上腺素试验有阳性反应的患者，Müller 肌结膜切除术是一种有效的治疗方法。
