Prevalence and Predictors of Hering's Response in Müller's Muscle-conjunctival Resection.

Abstract

PURPOSE:

Determine the prevalence and predictors of Hering's response following Muller's muscle-conjunctival resection (MMCR).

METHODS:

Seventy-five consecutive patients undergoing unilateral MMCR were recruited in this prospective, multicenter, cohort study. Margin-reflex distance-1 (MRD1) of both eyelids was recorded preoperatively and postoperatively. One hundred forty-three variables were investigated as potential predictors of a late postoperative (≥3 months) Hering's response using regression analyses. Main outcome measures were Hering's response (≥0.5 mm descent of the unoperated eyelid from baseline), and a clinically relevant Hering's response (descent of the unoperated from baseline to a MRD1 ≤ 2.0 mm, or descent from baseline such that the MRD1 of the unoperated eyelid became >1 mm lower than the operated eyelid).

RESULTS:

Twenty-four (32.0%) patients had a late postoperative Hering's response, but only 6 (8.0%) responses were clinically relevant. A Hering's response at the immediate (OR 16.24, p = 0.02) and 1-week postoperative (OR 8.94, p = 0.04) timepoints predicted a late postoperative response. However, the presence (OR 7.84, p = 0.07) and amplitude (OR 8.13, p = 0.06) of a preoperative phenylephrine Hering's response did not predict a late postoperative response. Of the 10 patients with a clinically relevant phenylephrine Hering's response, only 1 demonstrated a clinically relevant response late postoperatively.

CONCLUSION:

Unilateral MMCR induces a clinically relevant Hering's response in 8% of patients. A preoperative phenylephrine Hering's response does not predict a late postoperative Hering's response. Therefore, when unilateral phenylephrine testing unmasks contralateral blepharoptosis, only the side with blepharoptosis at baseline should be operated.

• Authors: Charlotte Lussier, Victoria C Leung, Jessica El-Khazen Dupuis, Davin C Ashraf, Oluwatobi O Idowu, Erika Massicotte, M Reza Vagefi, Robert C Kersten, Evan Kalin-Hajdu
• Journal: Ophthalmic plastic and reconstructive surgery (Ophthalmic Plast Reconstr Surg) 2023 May-Jun 01 Vol. 39 Issue 3 Pg. 237-242 ISSN: 1537-2677 [Electronic] United States
• PMID: 36700873 (Publication Type: Multicenter Study, Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2022 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.

Chemical References

• Phenylephrine

Topics

• Humans
• Blepharoptosis (surgery)
• Cohort Studies
• Prevalence
• Prospective Studies
• Retrospective Studies
• Eyelids (surgery, physiology)
• Oculomotor Muscles (surgery)
• Phenylephrine
• Blepharoplasty