الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Muller Muscle conjunctival resection (MMCR), originally described by Fasanella and Servat and later modified by Putterman and Urist, has traditionally been performed for correction of mild to moderate upper eyelid ptosis, resulting in improved eyelid height. It was thought that eyelid elevation is achieved by vertical shortening of the posterior lamella, plication or advancement of the MM, and levatoraponeurosis and cicatricial changes. The definitive mechanism is still a matter of debate. A prospective non randomized study. was carried on patients attending Outpatient Clinic of Ophthalmology in Menoufiya University Hospital during the period of study. This study was conducted on 20 eyes of patients with ptosis(mild to moderate ptosis with good to fair levator function). Proper assessment of ptosis was done including history and clinical examination .Phenylephrine done using 2.5% concenteration. Muller muscle conjunctival resection done as following: Local anathesia without adrenaline was injected above the lid margin. A traction suture was placed at the highest point of the lid margin, and the lid was everted over aDesmarres retractor. Conjunctiva and Muller’s muscle were incised just above the upper border of the tarsal plate. The plane between Muller’s muscle and the levatora poneurosis was identified and blunt dissection on this plane was extended upwards Muller’s muscle was then lifted with the adherent conjunctiva up to the level of the fornix. Careful dissection of Muller’s muscle from the medial side as well as lateral side to avoid peaking of the eyelid. A 6/0 vicryl suture was placed through the conjunctiva and Muller’s muscle at the level of planned new insertion, then through the upper border of the tarsal plate then through the conjunctiva and Muller’s muscle again.Before tying the sutures, Desmarres retractor is removed . Two further similar sutures were placed through the same structures medially and laterally, and also tied .Then Muller’s muscle with the conjunctiva is resected. Follow up of the patients was done at 1 week, 1month, 3 months, 6 months postoperative using MRD1 and comparison was done with MRD1 before surgery.There was significant increase in MRD1 after surgery. Success of the operation was determined by postoperative eyelid elevation Patients were divided into 3 categories 1-Successful (eyelid elevated to cover 2mm of the cornea or within 0.5mm of this level) and they were 12 eyelids (60%) 2—Accepted (within 1mm of normal eyelid level which covers 2mm of the cornea) and they were 8 eyelids (40%) 3-Failed (uncorrected 0%) So,Open sky mullerconjunctival resection surgery has reasonable success rate in treating mild to moderate ptosis with fair to good levator function .It also has few and mild complication with the advantage of good cosmetic results due to avoidance of cutaneous scar and results in good eyelid contour.The procedure has short operation time and better learning curve than other many procedure.