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The aim of this study is to propose a new algorithm that helps to predict outcomes in the transconjunctival correction of moderate to severe blepharoptosis. This study included adult patients with moderate to severe upper eyelid ptosis treated between 2019 and 2021. Patients meeting inclusion criteria underwent ptosis correction through a posterior approach using an algorithm: 4\u00a0mm Mueller\u2019s muscle transconjunctival resection to correct 1\u00a0mm ptosis (depending on a test with 10% phenylephrine: 3\u201312\u00a0mm)\u2009\u00b1\u2009tarsal plate resection: 1\u00a0mm for every 1\u00a0mm of residual ptosis after phenylephrine test, but leaving a minimum of 4\u00a0mm upper tarsus intact. Outcomes were ovserved within at least 6-months. Outcomes were assessed based on pre- and postoperative MRD1 changes, inter-eyelid height symmetry, cosmetic effect, and complications. Outcomes of 118 procedures in 81 patients (average age 69, range: 47\u201387) were analyzed. MRD1 changes were statistically significant, from 0.2\u2009\u00b1\u20091.6\u00a0mm before to 4.1\u2009\u00b1\u20091\u00a0mm after surgery. The function of the levator palpebrae superioris muscle was 10.2\u2009\u00b1\u20093.4 (range 5\u201317) mm. Upper eyelid lifted by an average of 1.8\u2009\u00b1\u20090.7 (range 0\u20133) mm after the instillation of 10% phenylephrine eyedrops. An average of 8.5\u2009\u00b1\u20090.8 (range 8\u201310) mm of conjunctiva and Mueller\u2019s muscle and 2.2\u2009\u00b1\u20090.9 (range 1\u20135) mm of the tarsal plate were resected during the procedure. Inter-eyelid height symmetry within 1\u00a0mm was achieved in 95% of outcomes. The algorithm introduced in this study appears to be useful to achieve repeatable satisfactory outcomes in the transconjunctival correction of moderate to severe upper eyelid ptosis in adults with at least \u201dfair\u201d levator function.<\/jats:p>","DOI":"10.1038\/s41598-024-52990-9","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T08:03:55Z","timestamp":1706688235000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A new algorithm for the transconjunctival correction of moderate to severe upper eyelid ptosis in adults"],"prefix":"10.1038","volume":"14","author":[{"given":"Izabela","family":"Nowak-Gospodarowicz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Kici\u0144ska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Kinasz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"R\u0119kas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"52990_CR1","first-page":"54","volume-title":"Oculofacial Plastic Surgery","author":"AM Putterman","year":"2004","unstructured":"Putterman, A. 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