Müller Muscle-conjunctival Resection with or without Tarsectomy and Combined with Bandage Contact Lens Use in Ptosis Patients with Corneal Graft
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Purpose: To examine the efficacy of ptosis correction with a Müller muscle-conjunctival resection with or without tarsectomy(MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients. Methods: Seven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperativevisual acuity, marginal reflex distance 1 (MRD-1), presence of Hering’s dependency by the phenylephrine test, symmetry outcomes,and complications after MMCR±T. Results: The average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up timeof 10.4 months after MMCR±T. Hering’s dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 wasincreased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ± 0.55 mm, andthe mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5–1mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obviouscorneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well toleratedby all patients. Conclusions: Most patients achieved good surgical outcomes with the application of the BCL to protect the graft and withthe use of the phenylephrine test and Hering’s dependency to predict the final eyelid position and symmetry. MMCR±T combinedwith BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.
Abstract
Purpose: To examine the efficacy of ptosis correction with a Müller muscle-conjunctival resection with or without tarsectomy(MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients. Methods: Seven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperativevisual acuity, marginal reflex distance 1 (MRD-1), presence of Hering’s dependency by the phenylephrine test, symmetry outcomes,and complications after MMCR±T. Results: The average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up timeof 10.4 months after MMCR±T. Hering’s dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 wasincreased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ± 0.55 mm, andthe mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5–1mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obviouscorneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well toleratedby all patients. Conclusions: Most patients achieved good surgical outcomes with the application of the BCL to protect the graft and withthe use of the phenylephrine test and Hering’s dependency to predict the final eyelid position and symmetry. MMCR±T combinedwith BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.
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