Bishop hook Procedure
This video demonstrates surgical techniques used in isolating and re-recessing a tightly contracted inferior rectus muscle which had been previously recessed 8 mm. The patient had severe thyroid-related orbitopathy and had previously undergone an orbital decompression. The inferior rectus muscle of the left eye is situated inferiorly, the medial rectus to the left and the lateral rectus to the right of the screen. After dissecting and excising scar tissue, the inferior rectus muscle is isolated on a Jamieson hook. Its insertion is found 15 mm from the limbus. The forced duction test is strongly positive. A second muscle hook is introduced in order to define the free edges of the muscle. A small malleable brain retractor is used to retract the lower lid and Tenon’s capsule away from the surface of the inferior rectus muscle. A Bishop muscle hook is designed to facilitate exposure for safe placement of a suture when working in tight quarters. The Bishop hook is introduced under the muscle insertion and the Jamieson hook removed. The suture is woven through the muscle with the needle riding safely on the surface of the underlying metal plate of the Bishop hook. Both medial and lateral borders of the muscle are secured to the two arms of  the double-armed suture. Disinsertion of the muscle is also performed on the surface of the metal plate. The intact connection of the preplaced suture is verified repeatedly during this procedure. The two arms of the suture are inserted on the globe at a position 5 mm from the limbus and the muscle is allowed to hand back 19-20 mm from the limbus and tied in a bow to be used for future adjustment purposes. The conjunctiva is reinserted on the globe in a recessed position 7 mm from the limbus.