Predictive value of a phenylephrine-guided resection algorithm in optimizing eyelid symmetry following bilateral...

Area of Science:

• Ophthalmology
• Surgical Techniques
• Eyelid Surgery

Background:

• Mild-to-moderate ptosis can affect eyelid symmetry and visual function.
• Hering's phenomenon, the equal innervation of yoke muscles, can complicate bilateral ptosis repair.
• Accurate preoperative assessment is crucial for optimizing surgical outcomes in ptosis correction.

Purpose of the Study:

• To evaluate the anatomical, functional, and aesthetic outcomes of phenylephrine-guided bilateral Müller muscle-conjunctival resection (MMCR).
• To assess the efficacy of a standardized resection algorithm accounting for Hering's phenomenon in optimizing eyelid symmetry.
• To determine the predictability and safety of this technique for mild-to-moderate ptosis.

Main Methods:

• Retrospective clinical study of patients with mild-to-moderate ptosis and good levator function.
• Simultaneous bilateral MMCR performed using a phenylephrine-based resection algorithm.
• Preoperative and postoperative evaluation of best-corrected visual acuity (BCVA) and margin reflex distance-1 (MRD-1) at 1 and 3 months.

Main Results:

• Significant improvement in MRD-1 observed postoperatively in both eyes (p < 0.001).
• Excellent or satisfactory eyelid symmetry achieved in 94.9% of patients.
• Revision surgery was required in only 8.4% of cases.

Conclusions:

• Phenylephrine-guided bilateral MMCR with a standardized algorithm is a safe and effective method for correcting mild-to-moderate ptosis.
• The technique allows for accurate bilateral surgical planning in a single session by accounting for Hering's phenomenon.
• This approach offers a predictable and potentially less invasive alternative for ptosis repair, improving eyelid symmetry.