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Muller Muscle-conjunctival Resection with or without Tarsectomy and Combined with Bandage Contact Lens Use in Ptosis Patients with Corneal Graft

Korean Journal of Ophthalmology 2021년 35권 1호 p.10 ~ 17
Mangan Mehmet Serhat, Ocak Serap Yurttaser, Vural Ece Turan, Yildiz Elvin,
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 ( Mangan Mehmet Serhat ) - Haydarpasa Numune Education and Research Hospital Sadik Eratik Eye Clinic Division of Ophthalmic Plastic and Reconstructive Surgery
 ( Ocak Serap Yurttaser ) - Okmeydani Education and Research Hospital Department of Ophthalmology
 ( Vural Ece Turan ) - Haydarpasa Numune Education and Research Hospital Sadik Eratik Eye Clinic Division of Cornea
 ( Yildiz Elvin ) - Haydarpasa Numune Education and Research Hospital Sadik Eratik Eye Clinic Division of Cornea

Abstract


Purpose: To examine the efficacy of ptosis correction with a Muller 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.

키워드

Blepharoptosis; Contact lenses; Muller muscle-conjunctival resection; Penetrating keratoplasty; Tarsectomy

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