Adjustable medial rectus muscle resection
In this video we demonstrate a medial rectus muscle resection with adjustable sutures. The lower border of the muscle is towards the top of the screen and the upper border towards the lower part of the screen. A conjunctival peritomy has been completed and the medial rectus muscle has been isolated on a Jamieson hook.. Using blunt and sharp dissection, check ligaments are separated from the outer surface of the muscle and intermuscular membranes are dissected away from the upper and lower borders of the muscle. A second muscle hook is placed under the muscle and retracted posteriorly. A double-armed 6-0 vicryl suture with spatula needles is woven through the full width of the muscle 4 mm from the insertion site. The suture is locked to both the upper and lower borders of the muscle. The muscle is then transacted just anterior to the preplaced suture. The security of the sutures is verified prior to complete disinsertion. The muscle attached to the insertion site is excised and bleeding vessels are cauterized with a low-temperature disposable cautery.. The muscle is then reinserted at the original insertion site using partial thickness scleral bites. The two ends of the suture are tied in a “half” bow. This will allow for further adjustment in muscle position after the ophthalmoplegic effects of the retrobulbar anesthetic have worn off, or after the patient has fully awakened from general anaesthesia. The conjunctiva is then reinserted in a recessed position 4 mm back from the limbus and sutured in place using 6-0 vicryl interrupted sutures.