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Purpose The aim of this study was to compare the accuracy and clinical outcome of closed versus open-sky approach of Muller muscle–conjunctival resection for correction of mild and moderate ptosis with good levator function and positive phenylephrine test. Patients and methods A prospective comparative nonrandomized interventional study was conducted on patients attending the Outpatient Clinic of the Ophthalmology Department in Al Azhar University Hospital (Damietta branch) during the period from April 2018 to August 2019. The study was conducted on 50 eyelids of 45 patients with mild to moderate ptosis with good levator function and positive phenylephrine test. The patients were treated with either a closed or open-sky approach of Muller muscle–conjunctival resection, with 25 eyelids being treated by each approach. A total of 40 cases had unilateral ptosis and five cases were bilateral. All cases were congenital except one case that was a Pancoast tumor causing preganglionic Horner’s syndrome. The eyelid elevation, marginal reflex distance 1, lid contour, dry eye, and symmetry between both eyelids were the main outcome measures. Results There were significant differences between the two groups regarding the postoperative marginal reflex distance 1 (3.64±0.44 mm in the open-sky approach vs. 3.18±0.53 mm in the closed approach, P=0.002). There was significantly more correction of the degree of ptosis in the open-sky approach. Undercorrection was reported in 4% of the cases in the open-sky approach versus 28% in the closed approach, whereas temporal flare was reported in only 4% of the cases in the open-sky approach (P=0.0047). There was a significant reduction in the postoperative tear film in the patients treated with the closed approach in comparison with those treated with open-sky approach (P=0.007). Conclusion The open-sky approach offered advantages over the closed approach, including the opportunity for adjustment of the lid height and reducing the risk of dry eye.

Purpose: To investigate the effect of Phenylephrine test on the upper eyelid crease position. Material and Methods: This study follows a prospective and analytical design and included patients with unilateral acquired involutional ptosis recruited between January 2015 and January 2018. In the Phenylephrine test, 1 drop of Phenylephrine 10% was instilled on the inferior fornix of the ptotic eye and the eyelid crease position was evaluated 10 min after. Results: A total of 60 patients were included in the final sample. The mean Margin‐to‐reflex distance 1 (MRD1) of the ptotic eye was 2.1 ± 1.0 and 3.8 ± 0.6 mm before and 10 min after the instillation of Phenylephrine, respectively. The difference between the means was statistically significant (p < 0.001). Ninety‐five per cent of the eyes had a positive Phenylephrine test result. Of this, 100% showed a decrease in the height of eyelid crease after the drop. There was a statistically significant decrease in the height of eyelid crease from 10.3 ± 2.5 to 7.8 ± 2.0 mm (p < 0.001). Conclusion: Phenylephrine test not only affects the eyelid position but also the eyelid crease height. We show a significative decrease in eyelid crease height to a symmetrical level with the contralateral lid in all patients that had a positive Phenylephrine test result. This effect is probably due to a posterior lamella shortening secondary to Müller's muscle contraction and suggests that the eyelid crease is not only determined by the projections of levator aponeurosis, but also by the entire force vector of the upper eyelid retractors. [ABSTRACT FROM AUTHOR]

Muller muscle-conjunctiva resection (MMCR) has been often considered to be relatively contraindicated in patients with previous glaucoma surgery. We investigate the glaucoma and ptosis outcomes in patients with glaucoma filtering blebs undergoing MMCR surgery. Retrospective cross-sectional case-control study at a single institution over a 15-year period on eyes of patients > 18 years of age who underwent MMCR surgery were included. Eyes were separated into 2 groups: 1) Ptosis with glaucoma filtering bleb(s) (case group); 2) Ptosis without a glaucoma filtering bleb (control group). The primary outcome measure was bleb failure. Secondary outcome measures were postoperative marginal reflex distance (MRD)1 and change in MRD1. 87 eyes from 80 patients met the inclusion criteria, with 29 eyes from 25 patients in the case group and 58 eyes from 55 patients in the control group. The mean (SD) length of MMCR follow-up and glaucoma follow-up after MMCR surgery were 7.3 (15.2) months and 16.4(9.3) respectively. Preoperatively, there were no significant differences between groups in terms of mean (SD) age [73 (13.2) vs 73.4 (13.1) years; p =.79] nor preoperative MRD1 [1.3 (0.2) vs. 1.4 (0.1) mm; p =.90]. There were no bleb-related complications. Three eyes (10.3%) were characterized as postoperative bleb failure. No significant differences in mean postoperative MRD1 nor mean change in MRD1 were noted (p=.34 and p =.15). Muller muscle-conjunctiva resection (MMCR) is an apparently safe and effective tool for the management of ptosis in patients with glaucoma filtering blebs. [ABSTRACT FROM AUTHOR]

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 postoperative visual 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 time of 10.4 months after MMCR±T. Hering's dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ± 0.55 mm, and the mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5-1 mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obvious corneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well tolerated by all patients., Conclusions: Most patients achieved good surgical outcomes with the application of the BCL to protect the graft and with the use of the phenylephrine test and Hering's dependency to predict the final eyelid position and symmetry. MMCR±T combined with BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.