Non-adjustable lateral rectus muscle recession Procedure
In this video we demonstrate a right lateral rectus muscle recession. In this view, the lateral rectus is below and the medial rectus above. We begin with the conjunctival peritomy. The conjunctival layer is grasped with toothed forceps just posterior to the limbus and above the lateral rectus muscle insertion and a radial incision is made with curved Westcott scissors. The conjunctival and Tenon’s layers are then grasped and Tenon’s capsule is penetrated by cutting in a posterior direction onto the sclera. The closed blades of the scissors are inserted into the sub-Tenon’s space and advanced towards the lower edge of the muscle insertion in a direction parallel to the limbus, underneath Tenon’s and the conjunctiva. The posterior blade of the scissors is then placed in the sub-Tenon’s space and a limbal peritomy is done. A second radial incision is performed at the lower end of the incision. An opening is made through the Tenon’s capsule in a posterior direction above the muscle insertion. A Jameson muscle hook is passed along the scleral surface posterior to the muscle insertion inferiorly and the muscle is isolated on the hook. A second opening is made through Tenon’s above the muscle insertion, and a second hook slipped around the insertion. 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. After fixating the insertion with a conjunctival forceps, a double-armed 6-0 vicryl suture with spatula needles is woven through the full width of the muscle just posterior to the insertion. The suture is locked to both the lower and upper borders of the muscle. The muscle is then disinserted. The security of the sutures is verified prior to complete transection. Bleeding vessels at the insertion site are cauterized with a low-temperature disposable cautery.. The lateral rectus muscle is then reinserted at a measured distance from the original insertion site. The first suture throw is held with a tying forceps until the knot is secured.. The conjunctiva is then reinserted at the limbus and sutured in place using 6-0 vicryl interrupted sutures.