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Muller's muscle conjunctival resection versus external levator advancement for ptosis repair: systematic review and meta-analysis

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Abstract

Purpose

To compare the outcome of Muller's muscle conjunctival resection (MMCR) versus external levator advancement (ELA) in patients undergoing ptosis surgery.

Methods

A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and a search of electronic information was conducted to identify all comparative studies of MMCR versus ELA in ptosis repair. The primary outcome measures were the post-operative marginal reflex distance (MRD1), ptosis under-correction, over-correction, and re-operation rate. Secondary outcome measures included cosmetic appearance, complications, operative time, and learning curve. Fixed-effect modelling was used for the analysis.

Results

Seven studies that enrolled 1038 eyelids were identified in the literature. There was no statistically significant difference between the MMCR and ELA groups in post-operative MRD1 (Mean Difference [MD] = 0.13, P = 0.28) and the rate of under-correction odds ratio [OR] = 0.49, P = 0.14). However, ELA had a significantly higher rate of over-correction (OR = 0.17, P = 0.04) and re-operations (OR = 0.26, P = 0.0001) compared to MMCR. For secondary outcomes, MMCR had an improved cosmetic appearance, lower total number of complications and shorter operation time (MD = − 10.96, P < 0.00001). Finally, the two techniques had no significant difference in the learning curves.

Conclusion

Both MMCR and ELA are effective techniques for the surgical correction of ptosis; however, MMCR surgery is a more predictable and robust technique compared to, ELA with lower rates of over-correction and re-operation.

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Availability of data and materials

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author notes

  1. Mohammad Karam and Abdulmalik Alsaif contributed equally to the paper as joint first authors.

Authors and Affiliations

  1. AlBahar Ophthalmology Center, Ibn Sina Hospital, AlSabah Medical Area, Ministry of Health, Shuwaikh, Kuwait, State of Kuwait

    Mohammad Karam, Abdulaziz Alotaibi, Eiman Shareef & Raed Behbehani

  2. Bachelor of Medicine and Bachelor of Surgery (MBChB), School of Medicine, University of Leeds, Leeds, UK

    Mohammad Karam, Abdulmalik Alsaif & Ahmad Abul

  3. Walsall Healthcare NHS Trust, Walsall, West Midlands, UK

    Abdulmalik Alsaif

  4. Faculty of Medicine, Kuwait University, Kuwait, State of Kuwait

    Ali Alkhabbaz

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  1. Mohammad Karam
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Contributions

MK and AA contributed equally to the paper as joint first authors in the study concept and design as well as data analysis and interpretation. AA and AA were responsible for data extraction and quality and bias assessment of included studies. AA, ES and all the other authors were responsible for drafting the manuscript. RB contributed to the supervision of the study and critical review. All authors read and approved the final manuscript.

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Correspondence to Mohammad Karam.

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Karam, M., Alsaif, A., Abul, A. et al. Muller's muscle conjunctival resection versus external levator advancement for ptosis repair: systematic review and meta-analysis. Int Ophthalmol 43, 2563–2573 (2023). https://doi.org/10.1007/s10792-023-02633-1

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  • DOI: https://doi.org/10.1007/s10792-023-02633-1

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