Refractive changes and higher-order aberrations after Müller muscle conjunctival resection: a prospective clinical study.

Purpose: To evaluate postoperative changes in corneal topographic parameters and higher-order aberrations (HOAs) following Müller muscle-conjunctival resection (MMCR) in patients with mild-to-moderate ptosis.

Methods: This prospective clinical study included patients who underwent MMCR after a positive phenylephrine test and with good levator function who were evaluated. Preoperative and postoperative best-corrected visual acuity (BCVA), margin reflex distance 1 and corneal parameters (flat meridian, steep meridian, simulated keratometry, maximum keratometry), along with HOAs including coma, trefoil, spherical aberration, secondary astigmatism and quadrifoil, were assessed at week 1, month 1 and month 3.

Results: A total of 50 eyes from 50 patients were included in the study. BCVA showed mild deterioration at week 1 but returned to baseline by month 3. At postoperative week 1, lagophthalmos was observed in 12% and superficial punctate keratopathy (SPK) in 14% of eyes; both resolved completely by month 1. Eyes with SPK showed significantly greater changes in trefoil compared with those without (p=0.01 and p=0.03 for 4 mm and 6 mm pupil diameters, respectively). A significant difference was found between preoperative and postoperative coma (p=0.04) and secondary astigmatism (p=0.03) values; however, these parameters returned to baseline levels by the third month postoperatively. Surgical success was achieved in 92% of cases. Undercorrection was seen in 6% and overcorrection in 2%, with no functional or cosmetic issues.

Conclusion: MMCR may cause corneal topographic changes during the early postoperative period. However, these changes appear transient, and MMCR remains a visually safe and refractively stable surgical option for suitable ptosis patients.