Balanced Plication of Müller Muscle Tendon Through Conjunctiva for Blepharoptosis Correction

Abstract

We developed a method for plication of the Müller muscle tendon through the conjunctiva for the correction of blepharoptosis.The locations of 5 skin slits were marked according to the double-fold shape requested by patients. The skin at points marked on the eyelid was penetrated for creation of slits measuring 2 to 3 mm in length. After turning the upper eyelid inside out, a 5-0 nylon suture was applied at the upper margin of the central part of the tarsal plate and pulled in the anterioresuperior direction for exposure of the vascular arcades of the superior conjunctiva. A 7-0 white nylon suture was introduced from the most medial slit (first slit) of the upper eyelid to the conjunctiva of the upper tarsal border, then back to the original slit, and tied. The needle was moved to the second slit through the intramuscular plane tunnel and pierced to the conjunctiva of the upper tarsal border. From the upper tarsal border, the needle was inserted into the same opening, involving the Müller muscle, and extracted from the conjunctiva. From here, the needle was inserted in the reverse direction via the upper tarsal border to the second skin slit. Again, the needle was moved to the third slit and the forth slit through the subcutaneous tunnel, and the same procedures were repeated. The needle was then extracted at the fifth slit (the most lateral slit). From here, the needle pierced the conjunctiva of the upper tarsal border, then back to the original slit, like at the first slit. Thereafter, the needle was moved to the forth slit through the subcutaneous tunnel, plicating the Müller muscle, as before. The same procedures were performed at the third and second slit, and the needle finally appeared at the first slit. Thereafter, the 6-0 nylon was tightened.From March 2011 to March 2012, 147 patients underwent an operation (14 males, 133 females; age range, 15-68 years). The mean (SD) width of the palpebral fissure showed an increase from 1.7 (0.5) mm (range, 1.0-2.5 mm). The mean (SD) amount of plication was 8.1 (2.8) mm (range, 4.0-14.0 mm). No significant correlation was observed between the amount of plication and increasing amount of width of the palpebral fissure (P = 0.496, Pearson correlation). Among the 147 patients who underwent an operation, 50 patients (34%) were very satisfied, 61 (41%) were satisfied, 26 (18%) found the results acceptable, and 10 were dissatisfied with the results.We think that our method is a simple and minimally invasive method for the correction of blepharoptosis.