Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
The Effect of Sedation in Addition to Local Anesthesia on the Success Rate of Muller Muscle Conjunctival Resection: Retrospective Clinical Study
Lokal Anestezi ile Birlikte Sedasyon Uygulamasının Müller Kası Konjonktival Rezeksiyonunun Başarı Oranına Etkisi: Retrospektif Klinik Çalışma
İbrahim ÖZDEMİRa , İrfan Botan GÜNEŞb
aBiruni University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
bKocaeli Health and Technology University Medicalpark Kocaeli Hospital, Department of Ophthalmology, Kocaeli, Türkiye
Turkiye Klinikleri J Ophthalmol. 2024;33(3):171-6
doi: 10.5336/ophthal.2024-102707
Article Language: EN
Full Text
ABSTRACT
 Objective: To evaluate the effect of sedative anesthesia applied during Muller muscle conjunctival resection (MMCR) on the success rate of the surgery. Material and Methods: Data from 41 eyes of 41 patients who underwent MMCR due to mild ptosis between October 2017 and December 2022 were examined retrospectively. The data obtained from 21 patients who received subconjunctival local anesthesia without epinephrine and intravenous midazolam (Group 1) were compared with the data of 20 patients who received only subconjunctival local anesthesia without epinephrine (Group 2). Margin reflex distance 1 (MRD1)>2.5 mm and MRD1<0.5 mm between the two eyes were accepted as success criteria after MMCR. Results: No significant difference was observed between the groups in terms of gender and age distribution (p=0.828 and p=0.961, respectively). Postoperatively, the mean MRD1 in the ptotic eye and the mean MRD1 difference between the two eyes were 4.2±0.2 and 0.4±0.08, respectively, in Group 1 and 4.0±0.1 ve 0.5±0.08 respectively, in Group 2. While MRD1 was found to be significantly higher in Group 1 (p=0.004), the MRD1 difference was significantly higher in Group 2 than Group 1 (p=0.017). The success rate was 95% in Group 1 and 81% in Group 2. Conclusion: We found that the success rate of the MMCR was higher in the group with sedation combined with local anesthetic without epinephrine. We believe that sedation increases patient comfort and surgical success, especially in Muller muscle surgeries where local anesthetics without epinephrine are preferred.

Keywords: Ptosis surgery; Muller muscle; sedation; local anesthesia
ÖZET
 Amaç: Müller kası konjonktival rezeksiyonu (MKKR) sırasında uygulanan, sedatif anestezinin operasyonun başarı oranına etkisini değerlendirmek. Gereç ve Yöntemler: Ekim 2017 ve Aralık 2022 yılları arasında hafif derecede pitozis nedeni ile MKKR uygulanan 41 hastanın, 41 gözüne ait veriler geriye dönük incelendi. Epinefrin içermeyen, subkonjonktival lokal anestezi ve intravenöz midazolam uygulanan 21 hastanın (Grup 1) verileri ile sadece subkonjonktival epinefrinsiz lokal anestezi uygulanan 20 hastanın (Grup 2) verileri karşılaştırıldı. MKKR sonrası, marjin refleks mesafesi 1 (MRM1)>2,5 mm olması ve iki göz arasında MRM1 farkının <0,5 mm olması başarı kriteri olarak kabul edildi. Bulgular: Gruplar arasında cinsiyet ve yaş dağılımı açısından anlamlı farklılık izlenmedi (sırasıyla p=0,828 ve p=0,961). Operasyon sonrası pitotik gözde ortalama MRM1 ve iki göz arasında ortalama MRM1 farkı Grup 1 de sırasıyla 4,2±0,2 ve 0,4±0,08 iken Grup 2 de sırasıyla 4,0±0,1 ve 0,5±0,08 idi. MRM1 Grup 1 de anlamlı düzeyde yüksek saptanırken (p=0,004) MRM1 farkı Grup 2 de Grup 1 den anlamlı düzeyde yüksek saptandı (p=0,017). Başarı oranı Grup 1 de %95, Grup 2 de ise %81 olarak saptandı. Sonuç: Epinefrin içermeyen lokal anestezik ile birlikte sedasyon uygulanan grupta, MKKR operasyonun başarı oranının daha yüksek olduğunu saptadık. Özellikle epinefrinsiz lokal anestezik tercih edilecek olan Müller kası cerrahilerinde sedatif anestezinin hasta konforunu ve operasyon başarısını arttırdığını düşünüyoruz.

Anahtar Kelimeler: Pitozis cerrahisi; Müller kası; sedasyon; lokal anestezi
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