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ERICK BOTHUN: So this is a strabismus case of esotropia and we're going to recess both media rectus muscles. I'm going to make a classic fornix wound about 8 millimeters back. So I hook the medial rectus and I try not to have the point come forward.
So now the muscle's nicely exposed, and there's really not much Tenon's to speak of and we'll go ahead and imbricate the muscle. Always when you trim a muscle off in fornix surgery, you trim towards the wound. And then we'll reattach the muscle. Nice and slow, controlled pass to get that 5 millimeter insertion recession. A double pass. Here's the next one in the locking way, or in a square knot fashion. If the wound doesn't want to close completely, you can lift up on its edge and get it to close. If there's any concern about gaping, you can always put an 8-0 vicryl.
On the other eye, we're going to reattach it in a slightly different way with what's called an adjustable suture. And this is a radial wound extending from the limbus towards the caruncle, just inferior to the medial rectus. And then you hook the medial rectus. Now that we've isolated the muscle, I can go ahead and imbricate through that radial fornix wound. Now we have a muscle that's imbricated we're cutting towards the fornix wound inferiorly, so in the same way, I can go in and trim off the rest of this muscle.
And here is where we deviate from the last case. Now, as performed in the hang back technique, we suture an adjustable noose, typically at the insertion. Same thing here. So I'm pressing down, going straight ahead. If I get thin, I can push down, continue that plane, and exit using my small hook if I'd like. And I'm setting that by placing this suture, these locked-- excuse me, setting the pull sutures and securing them to each other at this point.
We want to recess this muscle with an adjustable noose. At this point, we are going to put the noose in place, and we're ready to close the eye with a couple of 8-0 vicryl sutures, and I'll do that now before the case is completed.
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So that is a radial fornix wound, and you'll see here how nicely that comes together for potential adjustment tomorrow. Betadine at the end of the case, and we have successfully recessed both medial recti with adjustable on the right.
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