Investigators of this prospective study compared the efficacy of Müller muscle-conjunctival resection (MMCR) to external levator advancement (ELR) for aponeurotic blepharoptosis repair.

Study design

Patients with mild-to-moderate ptosis with good levator function and a positive phenylephrine test were randomized to MMCR (38 eyes) or ELR (39 eyes).

The primary outcome was margin reflex distance 1 (MRD1) at 1 month after surgery. Secondary outcomes were cosmetic outcomes, complications, and operating time.

Outcomes

Both groups showed significant and comparable improvements in MRD1 at 1-month postop.

Cosmetic outcomes were significantly better in the MMCR group than the ELR group (3.07 vs 2.69, respectively; P=0.020), whereas average operating room time was similar between the 2 procedures (71 vs 75 minutes, respectively; P=0.439). One eye in the MMCR group and 3 eyes in the ELR group underwent reoperation.

Limitations

The main strength of this study is its randomized design. However, the participants in this study were all Asian. Thus, the findings may not be applicable to other patient populations because cosmetic outcomes in Asian patients center mainly on the eyelid crease, which is affected differently by these 2 procedures.

The average operating time seemed rather long. A longer follow-up would have been desirable.

Clinical significance

The debate of ELR vs MMCR continues. This study supports the efficacy of both procedures in eyelid elevation in patients with mild-to-moderate ptosis with good levator function and a positive phenylephrine test. However, this study also suggests that MMCR offers a better cosmetic result than ELR in Asian patients.