Purpose: Although aponeurotic ptosis is typically bilateral, the specific risk factors for unilateral cases remain unclear. Thus, we aimed to identify factors associated with unilateral aponeurotic ptosis by comparing eyes that underwent surgery with their non-ptotic contralateral counterparts. Patients and Methods: This retrospective observational clinical study included patients who underwent levator resection for aponeurotic ptosis at the Fukui University Hospital, between April 1, 2014, and March 31, 2024, were included. The contralateral non-ptotic eye served as the internal control. The presence of risk factors, such as a history of filtering surgery, prostaglandin analog use, cataract surgery, and vitrectomy, was compared between the operated and fellow eyes using McNemar’s test. Firth’s penalized logistic regression analysis was performed to identify independent risk factors for unilateral aponeurotic ptosis. Results: Sixty-eight patients were included in the analysis, with both eyes (136 eyes in total) evaluated. Glaucoma filtering surgery, prostaglandin analog use, and cataract surgery were significantly more frequent in operated eyes (P = 0.004, P = 0.045, and P = 0.002, respectively). Multivariate analysis showed that filtering surgery odds ratio (OR) = 17.6, P = 0.009 and cataract surgery (OR = 2.07, P = 0.046) were independently associated with unilateral ptosis. Conclusion: Prior glaucoma filtering and cataract surgeries are significant risk factors for the development of unilateral aponeurotic ptosis. Keywords: unilateral aponeurotic ptosis, glaucoma filtering surgery, cataract surgery, prostaglandin analog, risk factors
Katsuo et al. (Sun,) studied this question.