Color Atlas Of Strabismus Surgery by Kenneth W. Wright & Yi Ning J. Strube

Author:Kenneth W. Wright & Yi Ning J. Strube
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Fig. 10.7A small Stevens hook behind the medial rectus muscle pulling the muscle straight up off the sclera (to the ceiling). A large Jameson hook is poised to be passed directly under the Stevens hook, parallel to the muscle insertion. After the Jameson hook is passed, the Stevens hook is removed

A rectus muscle may be inadvertently split during the process of hooking and isolating the muscle. If this split is not identified, only part of the muscle will be operated on. The split muscle is best identified by the pole test (Fig. 10.8). The pole test is performed by placing two small Stevens hooks to expose the entire upper muscle pole (i.e., the end of the insertion). The hook closest to the cornea (i.e., the anterior hook) is kept perpendicular to, and directly on, sclera, then rotated anteriorly around the muscle pole. If the muscle is split, the Stevens hook will be trapped by the residual muscle fibers, limiting the advancement of the hook. To correct this situation, the residual muscle fibers are hooked with the small hook, elevated, and placed on the large hook with the main body of the muscle. Incorporate the split portion of the muscle with the rest of the muscle by placing the locking bite around the split and through the main portion of the muscle. No real harm is done if the split muscle is identified and secured.

Fig. 10.8(a) and the split muscle fibers are hooked by the Stevens hook. (b) The corresponding photograph shows a split medial rectus muscle. Note the main body of the medial rectus on the large Jameson hook, with the split fibers on the Stevens hook. If the surgeon is not careful, the split muscle could be misidentified as residual anterior Tenon’s capsule or intermuscular septum

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