KMID : 0213520210350010010
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Korean Journal of Ophthalmology 2021 Volume.35 No. 1 p.10 ~ p.17
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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
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Mangan Mehmet Serhat
Ocak Serap Yurttaser Vural Ece Turan Yildiz Elvin
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Abstract
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Purpose: To examine the efficacy of ptosis correction with a Muller muscle-conjunctival resection with or without tarsectomy (MMCR¡¾T), combined with bandage contact lens (BCL) use, in corneal graft patients.
Methods: Seven patients with corneal grafts who underwent MMCR¡¾T 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¡¾T.
Results: The average duration between the penetrating keratoplasty and MMCR¡¾T was 14 months, with a follow-up time of 10.4 months after MMCR¡¾T. Hering¡¯s dependency was observed in four (57.2%) patients before MMCR¡¾T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ¡¾ 0.55 mm, and the mean postoperative MRD-1 was 2.35 ¡¾ 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5?1 mm), and fair (¡Ã1 mm) were noted after MMCR¡¾T 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¡¾T combined with BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.
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KEYWORD
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Blepharoptosis, Contact lenses, Muller muscle-conjunctival resection, Penetrating keratoplasty, Tarsectomy
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