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    Investigators evaluated the efficacy of intraoperative adjustments during external levator resection for involutional ptosis.

    Study design

    The study included 15 patients (23 eyelids) who underwent levator advancement surgery for ptosis repair via a standardized algorithm with and without intraoperative adjustment. The authors calculated the difference between their target and measured marginal reflex distance 1 (MRD-1). The outcomes were compared to a historical cohort of 14 patients (25 eyelids).


    Patients were followed for 6 months. Both groups achieved excellent and statistically similar outcomes; on average, MRD-1 was within 0.2 mm of target. Surgeries performed without intraoperative adjustment were on average 4.3 minutes faster.


    The study was not double-blind in nature, thereby possibly introducing bias.

    Clinical significance

    Intraoperative adjustment during external levator resection may not be necessary. This finding challenges conventional dogma, and the authors suggest a standardized algorithm for ptosis repair.