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Modified Müller’s muscle conjunctival resection combined with levator plication in moderate to severe congenital ptosis with poor levator function
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  • Published: 26 January 2026

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

  • Amirhossein Aghajani1,
  • Seyed Mohsen Rafizadeh1,
  • Mohammad Taher Rajabi1,
  • Seyede Simindokht Hosseini2,
  • Hanieh Fakhredin3,
  • Hamidreza Ghanbari3 &
  • …
  • Amin Zand1 

Scientific Reports , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

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Abstract

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.

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Data availability

The datasets used during the current study are available on the Eye Research Center of the Farabi Eye Hospital, Tehran, Iran. The data is not available publicly due confidentiality. However, upon a reasonable request, the data can be obtained from the corresponding author.

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Acknowledgements

The authors are grateful to the research participants and all the hospital staff who took interest and helped out in the study.

Funding

The authors received no financial support for this research.

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Authors and Affiliations

  1. Department of Oculo-Facial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Amirhossein Aghajani, Seyed Mohsen Rafizadeh, Mohammad Taher Rajabi & Amin Zand

  2. Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Seyede Simindokht Hosseini

  3. Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, Iran

    Hanieh Fakhredin & Hamidreza Ghanbari

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  1. Amirhossein Aghajani
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Contributions

AA and SMR designed the study and supervised the project. AA performed ophthalmic examinations and the surgeries. HF and HG collected the data. SSH performed the statistical analysis. AA, HF, MBR, MTR and AZ wrote and revised the main manuscript text. All the authors read and approved the final manuscript.

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Correspondence to Hanieh Fakhredin.

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The study was approved by the Ethics Committee of Tehran University of Medical Sciences (ethics code: IR.TUMS.FARABIH.REC.1402.026). The research adhered to the ethical guidelines stipulated in the Declaration of Helsinki. Prior to enrollment in the study, written informed consent was secured from all participants or their respective legal guardians.

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Aghajani, A., Rafizadeh, S.M., Rajabi, M.T. et al. Modified Müller’s muscle conjunctival resection combined with levator plication in moderate to severe congenital ptosis with poor levator function. Sci Rep (2026). https://doi.org/10.1038/s41598-026-37431-z

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  • Received: 14 December 2024

  • Accepted: 22 January 2026

  • Published: 26 January 2026

  • DOI: https://doi.org/10.1038/s41598-026-37431-z

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Keywords

  • Congenital ptosis
  • Ptosis surgery
  • Müller’s muscle conjunctival resection
  • MMCR
  • Levator plication
  • Eyelid contour
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