Adrenergic receptors in the ptotic human eyelid: correlation with phenylephrine testing and surgical success in ptosis repair.
OBJECTIVE
To investigate the relationship between adrenergic receptors in Müller muscle and response to phenylephrine testing in patients undergoing ptosis surgery. This study also compares outcomes of Fasanella and Putterman approaches to posterior ptosis repair.


METHODS
Prospective analysis of 71 patients undergoing posterior ptosis surgery. Eyelid height was measured before and after phenylephrine. Müller muscle was examined for alpha-1D, alpha-2C, beta-1, and beta-2 receptors. Specimens were graded on receptor staining intensity. Patients were seen 1 week and 6 weeks following surgery. Surgical outcomes were scored on a scale of 1 (most favorable) to 3 (least favorable).


RESULTS
Adrenergic receptors were found in decreasing order: alpha-1D, beta-1, alpha-2C, and beta-2. Receptor grade significantly predicted eyelid height for alpha-2C receptors (p = .03). Mean outcome scores for 36 Putterman (1.10) and 35 Fasanella (1.27) procedures were not significantly different.


CONCLUSIONS
Alpha 1D, alpha-2C, and beta-2 receptors are documented within human Müller muscle. Human eyelid elevation response to phenylephrine is inversely related to the amount of alpha-2C receptor staining in Müller muscle. Fasanella and Putterman procedures have equal outcomes, independent of adrenergic receptors.
Skibell
Bentley C
BC
Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada.
Harvey
John H
JH
Oestreicher
James H
JH
Howarth
David
D
Gibbs
Alison
A
Wegrynowski
Trish
T
Wing
Tony
T
Deangelis
Dan D
DD
D000293:Adolescent; D000316:Adrenergic alpha-Agonists; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty; D001763:Blepharoptosis / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D002648:Child; D005143:Eyelids / Q000378:metabolism*; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000378:metabolism*; D010656:Phenylephrine; D011941:Receptors, Adrenergic / Q000378:metabolism*; D018340:Receptors, Adrenergic, alpha-1 / Q000378:metabolism; D018341:Receptors, Adrenergic, alpha-2 / Q000378:metabolism; D018342:Receptors, Adrenergic, beta-1 / Q000378:metabolism; D018343:Receptors, Adrenergic, beta-2 / Q000378:metabolism
C547719:ADRA1D protein, human; C547774:ADRA2C protein, human; D000316:Adrenergic alpha-Agonists; D011941:Receptors, Adrenergic; D018340:Receptors, Adrenergic, alpha-1; D018341:Receptors, Adrenergic, alpha-2; D018342:Receptors, Adrenergic, beta-1; D018343:Receptors, Adrenergic, beta-2; D010656:Phenylephrine