Surgical outcomes following Muller Muscle-Conjunctival Resection in patients with glaucoma filtering surgery

Abstract

ABSTRACT Purpose 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. Methods 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. Results 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). Conclusions Muller muscle-conjunctiva resection (MMCR) is an apparently safe and effective tool for the management of ptosis in patients with glaucoma filtering blebs.