The Wonder of Sutureless Mullerectomy.

Abstract

Background: Muller muscle-conjunctival resection (MMCR) is a possible treatment for some cases of ptosis. Corneal irritation or erosions are potential complications due to the use of sutures.

Objectives: Evaluating the efficacy and safety of sutureless MMCR as a treatment for moderate to severe ptosis, and to assess postoperative eyelid symmetry and surgical success rates.

Methods: Retrospective, single-center cohort study. Patients with a positive response to phenylephrine 10% underwent sutureless MMCR performed by the same surgeon. Pre- and postoperative margin-reflex distance 1 (MRD1) measurements were collected at baseline, one week, and eight weeks after surgery. Data was collected from files of 147 patients (252 eyes) with moderate to severe ptosis (MRD1 0-2 mm) who underwent sutureless MMCR between October2019 and October 2023.

Results: Surgical success (defined as postoperative MRD1 of ≥3 mm or ±0.5 mm of the preoperative MRD1 after phenylephrine instillation) was achieved in 88.5% of cases, with a mean MRD1 improvement of 1.61±0.89 mm (p<0.001). Symmetry (defined as ≤1 mm difference in MRD1 between eyes) was obtained in 93.3% of bilateral cases. There was no significant difference between preoperative MRD1 after phenylephrine and postoperative MRD1 at eight weeks (p=0.54). Female patients had higher surgical success rates (OR=2.22, 95% CI 1.01-4.95, p=0.047). Complications were minimal, with wound dehiscence occurring in 1.19% of cases. Statistical analysis, including univariable and multivariable regression, was performed to assess factors associated with surgical outcomes.

Conclusions: Sutureless MMCR demonstrated high success rates and postoperative symmetry, with low complication rates, supporting its efficacy as a reliable and minimally invasive procedure for the treatment of ptosis.