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Park, Ha, and Lew: Clinical Outcomes of Conjunctiva-Müller Muscle Resection and Factors Which Affect Success
Original Article

J Korean Ophthalmol Soc 2011;52(11):1263-1268.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.11.1263

Clinical Outcomes of Conjunctiva-Müller Muscle Resection and Factors Which Affect Success

Dae Il Park, MD, Sung Woo Ha, MD, Helen Lew, MD

Department of Ophthalmology, Bundang CHA Hospital, CHA University, Seongnam, Korea

Address reprint requests to Helen Lew, MD Department of Ophthalmology, Bundang CHA Hospital #351 Yatap-dong, Bundang-gu, Seongnam 463-712, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333, E-mail: eye@cha.ac.kr

Received 7 December 2010       Revised 26 April 2011       Accepted 22 September 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate clinical outcomes and to analyze the factors of successful treatment of conjunctiva-Müller muscle resection (CMMR) in patients with mild to moderate ptosis.

Methods

The medical records of 22 patients (30 eyes) with upper lid ptosis were retrospectively reviewed. All patients underwent conjunctiva-Müller muscle resections, and four patients (seven eyes) underwent concurrent upper lid blepharoplasty. The mean follow-up period was 81.62 ± 21 days. Pre- and post-operative MRD1, IPF and pupil to brow distance were measured using the Image J program. A preoperative phenylephrine test and a pathologic examination were performed to analyze the presence of Müller's muscle and the tear secreting glands from the CMMR specimens.

Results

The overall success rate of the procedure was 93%. Postoperatively, the MRD1 increased on average by 1.47 mm (p = 0.00) and increased by an average of 1.72 mm when the phenylephrine test response was greater than 2 mm and by 0.99 mm when the response less than 2 mm. The Müller muscle was observed in every specimen.

Conclusions

Conjunctiva-Müller muscle resection is an effective and safe method for treating mild to moderate ptosis, for which the preoperative phenylephrine test result is the most important factor for surgical success.

Keywords: Conjunctiva, MRD1, Müller muscle, Phenylephrine test, Ptosis

References

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Figure 1.
Pre and post operative MRD1, IPF, PBD are measured by image J program. MRD1 = marginal reflex distance; IPF = interpalpebral fissure; PBD = pupil to brow distance.
jkos-52-1263f1.tif
Figure 2.
A muscular dystrophy patient with bilateral ptosis was not corrected after CMMR. (A) Pre-op, (B) Post-op 1 month. CMMR = conjunctiva-Mller muscle resection.
jkos-52-1263f2.tif
Figure 3.
A patient with right eye ptosis was corrected successfully. (A) Pre-op, (B) Post-op 3 year.
jkos-52-1263f3.tif
Figure 4.
Amount of lid elevation after phenylephrine test (mm) and Δ MRD1 after conjunctiva-Müller muscle resection (mm) shows linear correlation. Δ = post – pre value; MRD1 = marginal reflex distance.
jkos-52-1263f4.tif
Figure 5.
(A) Müller's muscle (arrow) (H&E stain, ×200). (B) Conjunctival inflammation. Diffuse infiltration of many lymphocytes is noted (H&E stain, ×100). (C) Goblet cells (arrow) (H&E stain, ×400).
jkos-52-1263f5.tif
Table 1.
Clinical outcomes of conjunctiva-Müller muscle resection
Preoperative (mm) Post operative (mm) Difference (mm) p-value
MRD1 0.87 ± 1.16 2.35 ± 0.67 1.47 0.000*
IPF 5.62 ± 1.94 7.31 ± 1.58 1.68 0.000*
PBD 23.14 ± 5.48 23.25 ± 5.50 0.11 0.872

Data are presented as mean ± SD.

MRD1 = marginal reflex distance; IPF = interpalpebral fissure; PBD = pupil to brow distance.

* p-value ≤ 0.05.

Table 2.
The results of phenylephrine test in the patients for conjunctiva-Müller muscle resection
Amount of lid elevation at phenylephrine test ≥2 mm (n = 22) <2 mm (n = 8) p-value
Δ MRD1 1.74 ± 0.85 0.99 ± 0.61 0.030*
Δ IPF 2.21 ± 1.06 1.09 ± 0.64 0.050
Δ PBD 0.41 ± 0.94 0.61 ± 0.92 0.635

Data are presented as mean ± SD.

Δ = post – pre value; MRD1 = marginal reflex distance; IPF = interpalpabral fissure; PBD = pupil to brow distance.

* p-value ≤ 0.05.

Table 3.
The clinical outcomes of the patients treated with conjunctiva-Müller muscle resection using two hemostat clamps or Putterman clamps
Δ MRD1 (mm) Δ IPF (mm) Δ PBD (mm)
Two hemostat clamps (n = 14) 1.49 ± 1.08 1.69 ± 1.94 0.13 ± 1.48
Putterman clamp (n = 16) 1.46 ± 0.57 1.66 ± 1.58 0.11 ± 1.20
p-value 0.456 0.715 0.664
Total (n = 30) 1.47 1.68 0.11

Data are presented as mean±SD.

Δ = post – pre value; MRD1 = marginal reflex distance; IPF = interpalpabral fissure; PBD = pupil to brow distance.

Table 4.
The clinical outcomes of the patients treated with conjunctiva-Müller muscle resection or concurrent blepharoplasty
Δ MRD1 Δ IPF Δ PBD
CMMR (n = 23) 1.45 ± 1.06 1.67 ± 1.46 0.13 ± 1.40
CMMR+ blepharoplasty (n = 7) 1.49 ± 0.57 1.68 ± 1.88 0.12 ± 1.51
p-value 0.345 0.465 0.468
Total (n = 30) 1.47 1.68 0.11

Data are presented as mean±SD.

Δ = post – pre value; MRD1 = marginal reflex distance; IPF = interpalpabral fissure; PBD = pupil to brow distance.

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