Faden recession IR Procedure
This video illustrates the placement of a posterior fixation suture (Faden operation) in combination with an inferior rectus muscle recession. The right eye is positioned with the medial rectus to the right and the inferior rectus at the bottom of the screen. A limbal conjunctival incision is performed. Tenon’s capsule is penetrated temporally and the inferior rectus insertion is engaged with a Jamieson hook. The capsule is opened nasally and a second hook is slipped behind the insertion. The muscle is freed of check ligaments and intermuscular membranes. A 6-0 double-armed vicryl suture is woven through the muscle near its insertion site. Medial and lateral fixation of the muscle with the suture is completed. The muscle is disinserted and hemostasis is achieved. A 6-0 vicryl traction suture has been sutured into the muscle stump and the eye retracted superiorly. A narrow ribbon retractor retracts the detached inferior rectus and surrounding soft tissue inferiorly, providing access to the sclera posteriorly. A 5-0 non-absorbable suture with spatula needle is passed intrasclerally at a distance of 14 mm from the insertion site. The ribbon retractor is removed and the inferior rectus mobilized. The 2 arms of the posterior fixation suture are passed through the muscle belly, 11 mm from the distal end of the muscle, passing from scleral to external surface and straddling the central third of the muscle. The inferior rectus is pulled anteriorly and the two arms of the suture are then tied over the central third of the muscle. The traction suture is removed. The muscle is sutured to the scleral in a recessed position 3 mm from the insertion site.The conjunctiva is reinserted at the limbus.