Histopathologic Correlates and Functional Outcomes in Müller’s Muscle-Conjunctival Resection Using the Putterman Clamp
Author: Antonio Florido
Base Hospital / Institution: University of Calgary
ePoster presentation
Abstract ID: 25-395
Purpose
To evaluate the histopathological composition of tissues resected during Müller’s muscle-conjunctival resection (MMCR) using the Putterman clamp, correlate findings with postoperative outcomes, and contextualize results within the procedure’s historical evolution.
Methods
A prospective, single-center case series included 222 MMCR procedures on 126 patients (2023–2024). Resected tissues were categorized by two ophthalmic pathologists as smooth muscle (Müller’s), striated muscle (levator), or conjunctiva only. Smooth muscle length was quantified. Pre- and postoperative margin-reflex distance 1 (MRD1) were compared to calculate functional improvement (ΔMRD1) and correlated with tissue composition.
Results
Of 211 specimens, 199 (94%) contained smooth muscle, 2 (1%) striated muscle, and 12 (6%) conjunctiva alone. Smooth muscle was present along 73% ± 24% of the specimen. No significant correlation emerged between resection size and smooth muscle yield (Spearman R = –0.04, p=0.62).
The Smooth+/Skeletal– group showed the highest mean MRD1 gain (+1.90 mm), versus +1.45 mm (Smooth+/Skeletal+) and +1.20 mm (neither muscle). Most cases (78%) fell in the Smooth+/Skeletal– group, supporting the selective targeting of Müller’s muscle.
Conclusion
MMCR with the Putterman clamp consistently isolates Müller’s muscle with minimal levator inclusion, optimizing eyelid elevation. Superior outcomes occur when muscle is present either smooth or skeletal. Findings resolve prior controversies over MMCR mechanics and confirm the anatomical precision and clinical efficacy of the technique.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Ayman | Alghamdi | University of Calgary |
| Carson | Schell | University of Saskatchewan |
| Martin | Hyrcza | University of Calgary |
| Andrzej | Kulaga | University of Calgary |
| Ryan | Nugent | University of Calgary |
| Michael | Kryshtalskyj | University of Calgary |
| Karim | Punja | University of Calgary |
