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Challenging the current treatment of residual postoperative ptosis: safety and efficacy of repeat Müller's muscle conjunctival resection

      Abstract

      Objective

      To determine if repeat Müller's muscle conjunctival resection (MMCR) is a viable approach in the treatment of recurrent or residual eyelid ptosis.

      Methods

      A retrospective review of patients who underwent repeat MMCR was performed using external photos obtained preoperatively, postoperatively, and at last follow-up. The marginal reflex distances (MRD1 and MRD2), brow position (BP), and tarsal platform show (TPS) were evaluated with digital image analysis. The change in upper eyelid height (MRD1) and TPS following repeat ptosis repair were the outcome measures.

      Results

      Repeat MMCR was performed on 12 eyelids of 11 patients. Mean MRD1 elevation after initial MMCR was 1.6 mm (standard deviation [SD] = 1.0mm, p < 0.00001). Mean decrease in TPS was 1.9 mm (p = 0.04). There was no significant change in MRD2 (p = 0.36) or BP (p = 0.33) with initial MMCR. Mean interval between procedures was 12.8 months (range 2.3–48.0) and follow-up after repeat MMCR was 2.3 months. Total average follow-up after initial MMCR was 15.1 months. Mean elevation in MRD1 after repeat MMCR was 1.0 mm (SD = 0.8 mm, p < 0.002). Mean decrease in TPS was 1.0 mm (p = 0.03). There was no difference in MRD2 (p = 0.90) or BP (p = 0.53). There were no complications of repeat MMCR noted clinically or spontaneously reported, including no entropion, fornix foreshortening, or development of dry eye signs or symptoms.

      Conclusion

      Repeat MMCR significantly improves recurrent or residual ptosis after initial MMCR without significant adverse consequences. The degree of elevation with repeat MMCR was diminished when compared with initial MMCR.

      Résumé

      Objectif

      Déterminer si une reprise de la résection du muscle de Müller (RMM) représente une option viable dans le traitement du ptosis récurrent ou résiduel de la paupère.

      Méthodes

      Examen rétrospectif de dossiers de patients qui ont subi une reprise de la RMM par le biais de photos externes obtenues avant et après l'intervention de même qu’à la dernière visite de suivi. On a eu recours à une analyse d'images numériques pour mesurer la distance entre le reflet pupillaire et le bord libre (MRD1 et MRD2), la position des sourcils (PS) et l’étendue visible du tarse (TPS). La variation de la hauteur de la paupière supérieure (MRD1) et de la TPS à la suite de la reprise de la RMM a été retenue à titre de paramètre de mesure.

      Résultats

      Une deuxième RMM a été réalisée sur 12 paupières de 11 patients. L’élévation moyenne de la MRD1 après la RMM initiale se chiffrait à 1,6 mm (écart-type [é.-t.]  = 1,0 mm; p < 0,00001). La diminution moyenne de la TPS s’élevait à 1,9 mm (p = 0,04). On n'a enregistré aucune variation significative au chapitre de la MRD2 (p = 0,36) ni de la PS (p = 0,33) lors de la RMM initiale. L'intervalle moyen entre les interventions était de 12,8 mois (fourchette : 2,3–48,0), tandis que la durée du suivi après la reprise de la RMM était de 2,3 mois. La durée totale moyenne du suivi après la RMM initiale était de 15,1 mois. L’élévation moyenne de la MRD1 après la reprise de la RMM était de 1,0 mm (é.-t. = 0,8 mm; p < 0,002). La diminution moyenne de la TPS se chiffrait à 1,0 mm (p = 0,03). On n'a noté aucune différence au chapitre de la MRD2 (p = 0,90) ni de la PS (p = 0,53). La reprise de la RMM n'a entraîné aucune complication clinique ni de complication signalée spontanément, qu'il s'agisse d'entropion, de raccourcissement du fornix ou d'apparition de signes ou de symptômes de sécheresse oculaire.

      Conclusion

      La reprise de la RMM a permis une amélioration significative du ptosis récurrent ou résiduel de la paupière après la RMM initiale, sans qu'il se produise d'effets indésirables significatifs. Le degré d’élévation obtenu lors de la reprise était moindre qu'au moment de la RMM initiale.
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