Abstract Listings 2024

Purpose

This literature review aims to provide a comprehensive overview of the current understanding, indications, techniques, outcomes, and complications of Müller muscle-conjunctival resection (MMCR) surgery. It also addresses areas of debate with MMCR such as predictability concerning Phenylephrine response as well as the amount of muscle resection required.

Methods

This literature review was compiled based on the available evidence from PubMed from 1975 to August 2023 with comparative tables showing different practices and algorithms titrating the amount of Muller muscle resection to Phenylephrine response.

Results

The success rate of MMCR ranges from 72% to 95%, with high patient satisfaction reported in most studies. The exact range of eyelid elevation after MMCR is variable, with a reported average of 2.1 mm MRD1 elevation. There 7 different categories of surgical techniques to perform MMCR.
Pre-operative Phenylephrine has proven to be predictive in assessing postoperative eyelid and advises titration of resection based on the amount of response. Although it is a common practice to alter the amount of Muller muscle resection, the exact relationship between the amount of tissue resection and the final eyelid elevation is still a controversial topic with no uniform agreement amongst surgeons.

Conclusion

MMCR is an effective and safe surgical technique for the correction of mild to moderate upper eyelid ptosis with good LPS muscle function. The selection of appropriate candidates and an individualized surgical approach are crucial for achieving optimal outcomes. MMCR can achieve successful outcomes in aponeurotic and congenital ptosis cases. Although it is a straightforward technique, there are different surgical variations with different calculation algorithms. MMCR has a high patient satisfaction rate and low risk of complications

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