Abstract ID: 26-565
Rethinking Simultaneous MMCR in Bilateral Asymmetric Ptosis: Outcomes of a Graded Nomogram
Author: Altug Cetinkaya Base Hospital / Institution: Yüksek İhtisas Üniversitesi Tıp Fakültesi & Private Clinic, Ankara, Türkiye
Presentation Type: ePoster Presentation
Purpose
Simultaneous bilateral posterior-approach ptosis surgery in patients with asymmetric ptosis remains controversial because of concerns regarding postoperative asymmetry and unpredictability. This study evaluated outcomes of a surgeon-developed graded Müller muscle–conjunctival resection (MMCR) algorithm that individualizes resection amount according to required eyelid elevation, phenylephrine response grade, and levator function.
Methods
A retrospective review was performed of patients undergoing MMCR between 2012–2026 by a single surgeon. From 413 patients (457 eyelids), three groups were analyzed: bilateral symmetric ptosis treated with symmetric MMCR (20 patients, 40 eyelids), bilateral asymmetric ptosis treated with asymmetric MMCR using a graded nomogram strategy (26 patients, 52 eyelids), and an age-adjusted unilateral MMCR control group (92 patients, 92 eyelids). Surgical success was defined as postoperative inter-eyelid MRD1 asymmetry ≤1 mm.
Results
Baseline demographic and clinical characteristics were comparable between bilateral groups (all p>0.05). Mean resection amount was similar between symmetric and asymmetric bilateral groups (8.63±1.15 mm vs 8.58±1.08 mm). In the asymmetric group, the more ptotic eyelids underwent significantly greater resection (9.30±0.90 mm vs 7.87±0.71 mm, p<0.001) and achieved greater MRD1 elevation (2.13±0.73 mm vs 1.25±0.77 mm, p<0.001). Despite asymmetric dosing, final postoperative MRD1 values were comparable between eyelids (3.63±0.67 mm vs 3.74±0.68 mm, p=0.540). Surgical success was achieved in 100% of symmetric bilateral cases, 96.2% of asymmetric bilateral cases, and 97.8% of unilateral controls (p=0.560).
Conclusion
A graded MMCR nomogram provided predictable postoperative symmetry in bilateral asymmetric ptosis patients undergoing simultaneous surgery, with outcomes comparable to symmetric bilateral and unilateral MMCR. These findings challenge the traditional reluctance toward simultaneous posterior-approach surgery in asymmetric ptosis and support individualized differential resection planning.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Demet | Yabanoğlu | Hacettepe Üniversitesi Tıp Fakültesi, Ankara, Türkiye |
| Arife Esra | Kocakaya | Dünyagöz Hastanesi, İzmir, Türkiye |