The main prognostic factors influencing the results of the superior tarsal muscle resection in patients with blepharoptosis

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Transconjunctival methods of ptosis correction gain popularity nowadays. The wide use of the technique is limited because of the lack of clear recommendations regarding the volume of the resection, especially in patients with negative phenylephrine test.

Purpose. To assess the influence of main predictive factors on superior tarsal muscle (STM) resection result.

Materials and methods. Patients were divided into two groups according to the result of phenylephrine test (PE). Patients with positive results were included in the first group, with negative and weak results – in the second group. All patients underwent STM resection according our new algorithm.

Results. The result of STM resection was influenced by PE test and intraoperative white line motility test (WLM), but not by levator function and the amount of superior tarsal muscle resection.

Conclusions. PE and WLM tests play main role in choosing a method for blepharoptosis correcting.

About the authors

Elena V. Goltsman

City Multidisciplinary Hospital No. 2

Author for correspondence.
Email: ageeva_elena@inbox.ru

ophthalmologist

Russian Federation, Saint Petersburg

Vitaly V. Potemkin

City Multidisciplinary Hospital No. 2, Academican I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: potem@inbox.ru

PhD, Assistant Professor. Department of Ophthalmology; Ophthalmologist

Russian Federation, Saint Petersburg

Dmitriy V. Davydov

Peoples’ Friendship University of Russia

Email: d-davydov3@yandex.ru

MD, PhD, DMedSc, Professor, Head of Department, Reconstructive Surgery Department with Ophthalmology Course

Russian Federation, Moscow

References

  1. Finsterer J. Ptosis: causes, presentation, and management. Aesth Plast Surg. 2003;27(3):193-204. https://doi.org/10.1007/s00266-003-0127-5.
  2. Edmonson BC, Wulc AE. Ptosis evaluation and management. Otolaryngol Clin N Am. 2005;38(5):921-946. https://doi.org/10.1016/j.otc.2005.08.012.
  3. Crawford JS. Repair of ptosis using frontalis muscles and fascia lata a 20-year review. Ophthalmic Surg. 1977;8(4):31-40.
  4. Rycroft BW. The transconjunctival and transcutaneous approach to levator resection in the treatment of ptosis. In: Troutman R, Converse J, Smith B, editors. Plastics and reconstructive surgery of the eye and adenexa. London: Butter-worth; 1962.
  5. Patel V, Salam A, Malhotra R. Posterior approach white line advancement ptosis repair: the evolving posterior approach to ptosis surgery. Br J Ophthalmol. 2010;94(11):1513-1518. https://doi.org/10.1136/bjo.2009.172353.
  6. Ichinose A, Leibovitch I. Transconjunctival levator aponeurosis advancement without resection of Müller’s muscle in aponeurotic ptosis repair. Open Ophthalmol J. 2010;4:85-90. https://doi.org/10.2174/1874364101004010085.
  7. Lake S, Mohammad-Ali FH, Khooshabeh R. Open sky Müller’s muscle-conjunctiva resection for ptosis surgery. Eye. 2003;17(9):1008-1012. https://doi.org/10.1038/sj.eye.6700623.
  8. Dresner SC. Further modifications of the Müller’s muscle-conjunctival resection procedure for blepharoptosis. Ophthal Plast Reconstr Surg. 1991;7(2):114-122. https://doi.org/10.1097/00002341-199106000-00005.
  9. Beard C. History of ptosis surgery. Adv Ophthalmic Plast Reconstr Surg. 1986;5:125-131.
  10. Fasanella R, Servat J. Levator resection for minimal ptosis. Another simplified operation. Arch Ophthalmol. 1961;65:493-496. https://doi.org/10.1001/archopht.1961.01840020495005.
  11. Putterman AM, Urist MJ. Müller muscle-conjunctiva resection. Technique for treatment of blepharoptosis. Arch Ophthalmol. 1975;93(8):619-623. https://doi.org/10.1001/archopht.1975. 01010020595007.
  12. Perry JD, Kadakia A, Foster JA. A new algorithm for ptosis repair using conjunctival Mullerectomy with or without tarsectomy. Ophthal Plast Reconstr Surg. 2002;18(6):426-429. https://doi.org/10.1097/00002341-200211000-00007.
  13. Потёмкин В.В., Гольцман Е.В. Интраоперационный тест оценки подвижности белой линии при трансконъюнктивальной резекции верхней тарзальной мышцы по поводу блефароптоза // Офтальмологические ведомости. – 2019. – Т. 12. – № 4. – C. 87–91. [Potyomkin VV, Goltsman EV. White line motility test in transconjunctival muellerectomy for blepharoptosis. Ophthalmology journal. 2019;12(4):87-91. (In Russ.)]. https://doi.org/10.17816/ov15811.
  14. Потёмкин В.В., Гольцман Е.В. Новый алгоритм планирования резекции верхней тарзальной мышцы при блефароптозе: описание методики и результаты // Офтальмологические ведомости. – 2019. – Т. 12. – № 3. – С. 83–90. [Potyomkin VV, Goltsman EV. New algorithm for planning superior tarsal muscle resection for blepharoptosis: description of technique and results. Ophthalmology journal. 2019;12(3): 83-90. (In Russ.)]. https://doi.org/10.17816/ ov16049.
  15. Dortzbach RK. Superior tarsal muscle resection to correct belpharoptosis. Ophthalmology. 1979;86(10):1883-1891. https://doi.org/10.1016/s0161-6420(79)35341-6.
  16. Baldwin HC, Bhagey J, Khooshabeh R. Open sky Muller muscle conjunctival resection in phenylephrine test-negative blepharoptosis patients. Ophthal Plast Reconstr Surg. 2005;21(4):276-280. https://doi.org/10.1097/01.iop.0000167789.39570.3e.
  17. Peter NM, Khooshabeh R. Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome. Eye (Lond). 2013;27(4): 519-524. https://doi.org/10.1038/eye.2012.303.
  18. Vanderson EA, Fatima CS, de Ary-Pires B, et al. The human superior tarsal muscle (Müller’s muscle): a morphological classification with surgical correlations. Anat Sci Int. 2010;85(1):1-7. https://doi.org/10.1007/s12565-009-0043-0.
  19. Glatt HJ, Fett DR, Putterman AM. Comparison of 2.5% and 10% phenylephrine in the elevation of upper eyelids with ptosis. Ophthalmic Surg. 1990;21(3):173-176.
  20. Grace Lee N, Lin L-W, Mehta S, Freitag SK. Response to phenylephrine testing in upper eyelids with ptosis. Digit J Ophthalmol. 2015;21(3):1-12.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Stages of modified superior tarsal muscle resection (a–d)

Download (368KB)
Indexing metadata
3. Fig. 2. Measurement of length of superior tarsal muscle resection

Download (91KB)
Indexing metadata
4. Fig. 3. Assessment of mobility of white line

Download (194KB)
Indexing metadata
5. Fig. 4. Stages of modified superior tarsal muscle resection

Download (300KB)
Indexing metadata
6. Fig. 5. Example of modified Muller muscle conjunctival resection in patient with negative phenylephrine test: a – before test; b – after test; c – intraoperative superior tarsal muscle length measurement, d – after surgical correction

Download (465KB)
Indexing metadata

Copyright (c) 2021 Goltsman E.V., Potemkin V.V., Davydov D.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies