The Wonder of Sutureless Mullerectomy

Abstract Background Muller muscle-conjunctival resection (MMCR) is a possible treatment for some cases of ptosis. Corneal irritation or erosions are potential complications due to the use of sutures. Objectives Evaluating the efficacy and safety of sutureless MMCR as a treatment for moderate to severe ptosis, and to assess postoperative eyelid symmetry and surgical success rates. Methods Retrospective, single-center cohort study. Patients with a positive response to phenylephrine 10% underwent sutureless MMCR performed by the same surgeon. Pre- and postoperative margin-reflex distance 1 (MRD1) measurements were collected at baseline, one week, and eight weeks after surgery. Data was collected from files of 147 patients (252 eyes) with moderate to severe ptosis (MRD1 0-2 mm) who underwent sutureless MMCR between October2019 and October 2023. Results Surgical success (defined as postoperative MRD1 of ≥3 mm or ±0.5 mm of the preoperative MRD1 after phenylephrine instillation) was achieved in 88.5% of cases, with a mean MRD1 improvement of 1.61±0.89 mm (p<0.001). Symmetry (defined as ≤1 mm difference in MRD1 between eyes) was obtained in 93.3% of bilateral cases. There was no significant difference between preoperative MRD1 after phenylephrine and postoperative MRD1 at eight weeks (p=0.54). Female patients had higher surgical success rates (OR=2.22, 95% CI 1.01-4.95, p=0.047). Complications were minimal, with wound dehiscence occurring in 1.19% of cases. Statistical analysis, including univariable and multivariable regression, was performed to assess factors associated with surgical outcomes. Conclusions Sutureless MMCR demonstrated high success rates and postoperative symmetry, with low complication rates, supporting its efficacy as a reliable and minimally invasive procedure for the treatment of ptosis.