Modified Müller’s muscle conjunctival resection combined with levator plication in moderate to severe congenital ptosis with poor levator function

To present a modified surgical technique for the correction of moderate to severe congenital ptosis with poor levator function. This prospective case series included 34 eyes from 34 patients with unilateral moderate to severe congenital ptosis, defined as marginal reflex distance-1 (MRD-1, the distance from the corneal light reflex to the upper eyelid margin in primary gaze) ≤ 2 mm and levator function (LF) ≤ 5 mm. The surgical approach combined Müller's muscle conjunctival resection with an extended range (12-17 mm) and levator plication. An "ideal" response was defined as a postoperative inter-eyelid MRD-1 difference of ≤ 0.5 mm, while an inter-eyelid MRD-1 difference of 0.5-1 mm was considered an "acceptable" response. Secondary outcomes included achieving an open visual axis. Eyelid contour, defined as the symmetry and smooth curvature of the upper eyelid margin relative to the contralateral eyelid, was objectively graded as excellent, good, fair, or poor based on curvature and symmetry with the contralateral eyelid. At the 6-month follow-up, the overall success rate was 76.5%, with 26.5% achieving an ideal response and 50.0% achieving an acceptable response. Among the 25 cases with visual axis obstruction due to ptosis, only 1 case (4%) failed to achieve an unobstructed visual axis at 6 months. The inter-observer agreement for eyelid contour grading was almost perfect, with a κ = 0.86. Excellent eyelid contour was achieved in 73.5% of cases at the 6-month follow-up. This modified surgical technique demonstrates favorable functional and aesthetic outcomes for treating moderate to severe congenital ptosis in young adults with poor levator function. Nevertheless, the study did not assess lash ptosis as a parameter, and potential preoperative predictive factors that may influence postoperative outcomes were not evaluated, representing important limitations.