Korean J Ophthalmol.  2007 Jun;21(2):65-69. 10.3341/kjo.2007.21.2.65.

Clinical Effects of Conjunctiva-Muller Muscle Resection in Anophthalmic Ptosis

• Ha SW
• Lee JM
• Jeung WJ
• Ahn HB

• KMID: 1101905
• DOI: http://doi.org/10.3341/kjo.2007.21.2.65

Abstract

PURPOSE: To evaluate the clinical effects of conjunctiva-Muller muscle resection through conjunctival incision in anophthalmic patients with mild ptosis. METHODS: Conjunctiva-Muller muscle resection was performed by one surgeon in 8 patients (8 eyes) who had received evisceration or enucleation and responded to 10% phenylephrine solution to correct ptosis. The average age of the patients was 35.87+/-13.4 years. Ptosis was seen from 1 to 34 months after evisceration or enucleation. The preoperative MRD 1 was -2 to 0.5 mm (average: -0.25+/-1.10 mm) and the difference of MRD 1 between before and after 10% phenylephrine use was 2.56+/-0.98 mm. The Muller muscle was resected 7.5 to 9 mm through conjunctival incision during surgery to match the MRD 1 of sound eye. Mean follow-up period after the operation was 2 to 16 months (average: 8.1 months). RESULTS: Postoperatively, the MRD 1 increased by 1.81+/-0.88 mm on the average, corresponding to the improvement in lid elevation after the use of 10% phenylephrine performed before resection. Surgery was successful in most patients, and postoperative difference in MRD 1 was less than 1 mm from the sound eye. No special postoperative complication was observed. CONCLUSIONS: Conjunctiva-Muller muscle resection is one of the effective methods of correcting mild ptosis in anophthalmic patients.

Keyword

Anophthalmic ptosis; MRD 1; Muller muscle

MeSH Terms

Adult
Anophthalmos/*complications
Blepharoptosis/etiology/*surgery
Conjunctiva/*surgery
Eyelids/physiopathology
Facial Muscles/*surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Muscle Contraction
Ophthalmologic Surgical Procedures/*methods
Time Factors
Treatment Outcome

Figure

• 

  Fig. 1 Pathologic biopsy of surgical resection after conjunctivomüllerectomy using H & E staining (A) and immunohistochemistry staining of smooth muscle actin (B). (×200)

• 

  Fig. 2 Patient 1. (A) patient with right anophthalmic ptosis. (B) elevation of right eyelid after instillation of 10% phenylephrine hydrochloride. (C) postoperative state of conjunctivomüllerectomy.

• 

  Fig. 3 Patient 2. (A) patient with left anophthalmic ptosis. (B) elevation of left eyelid after instillation of 10% phenylephrine hydrochloride. (C) postoperative state of conjunctivomüllerectomy.

• 

  Fig. 4 Clamping with two curved mosquito holders just above superior tarsal border.

Reference

1. Putterman AM, Urist MJ. Müller muscle-conjunctiva resection. Technique for treatment of blepharoptosis. Arch Ophthalmol. 1975. 93:619–623.

2. Karesh JW, Putterman AM, Fett DR. Conjunctiva-Müller's muscle excision to correct anophthalmic ptosis. Ophthalmology. 1986. 93:1068–1071.

3. Helms HA, Zeiger HE Jr, Callahan A. Complications following enucleation and implantation of multiple glass spheres in the orbit. Ophthal Plast Reconstr Surg. 1987. 3:87–89.

4. Woo HY, Chung EH, Won IG. Müller muscle-conjunctiva resection. J. Korean Ophth Soc. 1990. 31:1000–1005.

5. Massry GG, Hornblass A, Rubin P, Holds JB. Tarsal switch procedure for the surgical rehabilitation of the eyelid and socket deficiencies of the anophthalmic socket. Ophthal Plast Reconstr Surg. 1999. 15:333–340.

6. Perry JD, Kadakia A, Foster JA. A new algorithm for ptosis repair using conjunctival Müllerectomy with or without tarsectomy. Ophthal Plast Reconstr Surg. 2002. 18:426–429.

7. Weinstein GS, Buerger GF. Modification of the Müller's muscle-conjunctival resection operation for blepharoptosis. Am J Ophthal. 1982. 93:647–651.

8. Brown MS, Putterman AM. The effect of upper blepharoplasty on eyelid position when performed concomitantly with Müller muscle-conjunctival resection. Ophthal Plast Reconstr Surg. 2000. 16:94–100.

9. Buckman G, Jakobiec FA, Hyde K, et al. Success of Fasanella-Servat operation independent of Müller's smooth muscle excision. Am J Ophthal. 1989. 96:413–418.