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ERICK D. BOTHUN: So we're going to do a bilateral strabismus repair for this child, strabismus repair both eyes for esotropia. So this will be a BMR on the right side. The fornix wounds are best placed inferiorly here, about 8 millimeters back, because in this case, I'm starting inferiorly.
I'll try to do the majority of the muscle, passing partial thickness from just more than the center line to the inferior. I aim about a millimeter above the insertion. I come back with the fellow hand from back to front. Here I can place this and expose nicely and do a full-thickness pass from back to front. I pull both ends of the suture to make sure that lock bite is quite secure.
And then we're going to go to the opposite side, again, coming out a millimeter above the sclera, which is on the top part of that hook. So now I'm making that pass. I come through. I grab my suture and start pulling it right down on top of the muscle. At this point, the muscle is imbricated, and we're going to take it off the eye.
And go all the way across. Watch your conjunctiva to make sure we don't trim that. And I'm going to reattach this with a caliper now at 5 millimeters behind the insertion. I will expose that spot of depression where I made with the caliper, make a small pass, and press onto the sclera. And I will go back in at this point, and there's my mark.
I aim for the other suture in that direction, pulling the muscle up to the position that was at 5 millimeters recessed, throwing square knots down-- a second, a third, and a fourth. At this point, there's different ways of massaging a [INAUDIBLE] wound back into place, whether you use an instrument or use a Q-tip. And we've completed the first eye.
On the second side, I'll do what's called a hang-back technique, virtually identical on the other side. Small hook and a large hook passing directly behind, rotating up to the limbus. We have the entire muscle. But you just want to have a nice bare sclera here, especially if you're going to be doing a hang-back. But we'll clean off the muscle.
Any dissection you do, you want to stay right on the muscle belly. And in this case, we're doing a different attachment. So this is what's called a hang-back. And pass the suture now in front-- in the sclera in front of the muscle at the exact location of the original insertion. Caliper can be set on the same distance you want the muscle to be located behind the original insertion.
The same suturing technique, coming down just on top of the needle holder. So we can take off the top clamp, slide the muscle up underneath, pull the conj down, and we've finished bilateral medial rectus recession. One was suturing it to the sclera, the second with the hang-back. And a beautiful case. Thank you.
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