Bishop muscle hook with protective plate for use on tight rectus muscles. The metal plate on this instrument provides protection from inadvertent scleral penetration during suture placement or muscle disinsertion.
Bishop muscle hook IR
This video demonstrates the use of the Bishop muscle hook for the exposure, suturing and disinsertion of the inferior rectus muscle. The left eye is positioned with the medial rectus to the right and the inferior rectus at the top of the screen. A limbal conjunctival incision has been completed nasally and inferiorly. The inferior rectus insertion is engaged with a Jamieson hook temporally. After it is freed of check ligaments and intermuscular membranes and Lockwood’s ligament is partially disengaged, the Bishop hook is inserted under the inferior rectus and just behind its insertion. The Jamieson hook is removed. A 6-0 double-armed vicryl suture is woven through the muscle near its insertion site. The plate of the Bishop hook protects the underlying sclera as the needle is passed along its surface.. Medial and lateral fixation of the muscle with the suture is completed. Disinsertion of the muscle is done by cutting on the suface of the metal plate. Hemostasis is achieved. The 2 arms of the suture are reinserted at the insertion site and the muscle allowed to hang back a measured distance from the insertion site. The 2 arms of the suture are tied in a bow to be used for future adjustment purposes. The conjunctiva is reinserted in a recessed position to allow for later access for adjustment purposes.