Müller Muscle-Conjunctiva Resection

Putterman, Allen M.; Urist, Martin J.

doi:10.1001/archopht.1975.01010020595007

Cited by 353 publications

(99 citation statements)

References 5 publications

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“…The Fasanella–Servat procedure is suitable for mild ptosis and involves a blind approach with predominately tarso-conjunctival resection. In 1975 Putterman and Urist8 described their technique of MMCR. After separating the Muller's and conjunctiva from the surrounding structures a modified clamp was used and the tissue excised.…”

Section: Discussionmentioning

confidence: 99%

“…The transconjunctival route was probably the first method of surgery employed to shorten the levator muscle 2–6. Posterior approach surgery was further popularised utilising Muller's muscle and tarsoconjunctival resection 7 8. Traditionally this posterior approach is reserved for those with minimal ptosis and a positive response to phenylephrine test 7–9.…”

Section: Introductionmentioning

confidence: 99%

“…Histological studies have since shown that the tissue resected consisted of a predominately tarsoconjunctival layer10 11 and we now regard the Fasanella–Servat technique as a tarsoconjunctival resection. Muller's muscle conjunctival resection (MMCR) was first reported by Putterman in 1975,8 where he dissected Muller's blindly off its bed on the aponeurosis with the aid of a special clamp. This was found to be effective in mild phenylephrine-positive ptosis cases.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Posterior approach white line advancement ptosis repair: the evolving posterior approach to ptosis surgery

Patel

Salam

Malhotra

2010

British Journal of Ophthalmology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Posterior approach white line advancement ptosis repair: the evolving posterior approach to ptosis surgery

Patel

Salam

Malhotra

2010

British Journal of Ophthalmology

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“…8 Resection of Muller's muscle together with overlying conjunctiva (MMCR) was first reported by Putterman, where he dissected Muller's blindly off its bed on the aponeurosis with the aid of a special clamp. 9 This technique has been shown to be safe and effective with 90% of eyelids achieving within 1.5 mm symmetry of the fellow eye. 10 However, because of the blind capture of tissues with the clamp, the amount of Muller's muscle that is resected is variable and limited, and hence it has been predominantly popularised for patients with good levator function and a positive response to the phenylephrine test.…”

Section: Introductionmentioning

confidence: 95%

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

Peter

Khooshabeh

2013

Eye

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Purpose To evaluate short-and long-term success rates on isolated subtotal Muller resection in over 300 cases of ptosis over a 10-year period. Methods Clinical records were retrospectively evaluated for aetiology and severity of ptosis, levator function, response to phenylephrine, pre-and postoperative margin reflex distance of the upper lid (MRD1), postoperative lid contour and symmetry, complications and follow-up duration. Main outcome measures: change in MRD1 and eyelid contour. Surgical success: postoperative MRD1 Z2 and r4.5 mm, symmetry to within 1.0 mm and satisfactory contour. All patients were also sent patient satisfaction questionnaires, and invited to attend for a longer-term assessment of their surgical outcome. Results In total, 92 and 95% of 309 eyelids met all three criteria for success after an average follow-up of 4 and 47 months, respectively. Mean improvement in MRD1 was 2.56 mm. In all, 97% had postoperative MRD1 of Z2 and r4.5 mm and over 99% had an excellent contour. Altogether, 95 and 89% were within 1.0 and 0.5 mm symmetry of the fellow eye, respectively. In total, 51% of eyelids continued to rise, 17% maintained the same initial postoperative height, and 32% dropped by 1 mm or less. In all, 92% felt that their initial postoperative eyelid height had been maintained. Only 2% required repeat surgery and minor complications occurred in 4%. Conclusions Isolated subtotal Muller's resection is safe and effective for the repair of the majority of ptosis with moderate-togood levator function. It results in a more predictable height, which is maintained over time, less frequent contour abnormalities, and lower re-operation rates compared with anterior levator advancement.

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“…There were no subjective or objective symptoms or signs of dry eye in our patients, supporting findings in previous publications. 4,16,17 In fact, it appears that none of the elements necessary for a healthy tear film, including mucin secretors (goblet cells), lacrimal secretors (accessory lacrimal glands), and lipid secretors (meibomian glands) are significantly affected. 18 However, there are no long-term follow-up data available in these patients, and it may be that their tear film could be compromised in later years.…”

mentioning

confidence: 99%

Isolated Muller's muscle resection for the correction of blepharoptosis

Khooshabeh

Baldwin

2006

Eye

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Purpose To assess the outcome of isolated Muller's muscle resection with preservation of conjunctiva in patients with blepharoptosis and good to moderate levator function. Methods This study was designed as a prospective, nonrandomised case series. Thirty-four eyes of 27 blepharoptosis patients were operated on, who were phenylephrine test-negative as well as positive. Open-sky Muller's muscle resection was performed with preservation of the conjunctiva. Main outcome measures were increase in margin reflex distance (MRD1), eyelid contour, and symptoms and signs of dry eye. Results The mean increase in MRD1 was 2.75 mm. All but one patient (96%) had upper lid margins resting at or up to 1 mm below the limbus and obtained symmetry to within 0.5 mm of the fellow eye. No patients had symptoms or signs of dry eye. Conclusion Isolated Muller's muscle resection is effective for the correction of ptosis in patients with moderate to good levator function. This is irrespective of the lid's response to phenylephrine. Preservation of conjunctival tissue eliminates concerns about dry eye, and also preserves the full height of the fornix.

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Müller Muscle-Conjunctiva Resection

Cited by 353 publications

References 5 publications

Posterior approach white line advancement ptosis repair: the evolving posterior approach to ptosis surgery

Posterior approach white line advancement ptosis repair: the evolving posterior approach to ptosis surgery

Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome

Isolated Muller's muscle resection for the correction of blepharoptosis

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