39
Inferior Oblique Recession/Anterior Transposition

See Chapter 3.

A complete strabismus evaluation with determination of the detailed surgical plan is necessary.

Instrumentation

Lid speculum (e.g., Lancaster, Barraquer)

Needle holder

Sutures (4–0 silk suture, double-armed 6–0 Vicryl with spatula needle, 7–0 Vicryl suture)

Toothed forceps (e.g., Bishop-Harmon, 0.5 mm Castro-viejo)

Westcott scissors (rounded tips)

Cautery (bipolar forceps)

Muscle hook (e.g., Green, Jameson)

Gass muscle hook

Stevens tenotomy hooks

Iris spatula

Hartman mosquito hemostat

Desmarres retractor

Castroviejo caliper

Headlight

Operative Procedure

Note: Figures are drawn from the surgeon’s viewpoint with the surgeon standing at the head of the patient.

Note: Illumination of the surgical field is best obtained with a headlight.

1. Anesthesia: General anesthesia or retrobulbar/peribulbar injection plus eyelid block.

2. Place a drop of neosynephrine 2.5% into the eye to constrict the blood vessels and decrease bleeding. Prep and drape.

3. Place lid speculum.

4. Create conjunctival incision in the inferotemporal fornix (Fig. 39.1).

a. The assistant grasps the globe at the limbus at the inferotemporal limbus.

b. The assistant then exposes the inferior fornix by elevating and adducting the globe.

c. Create an 8 mm incision parallel to the fornix and 1 mm from the fornix on the bulbar conjunctiva with Westcott scissors.

5. Create a radial incision through the Tenon capsule to expose the sclera (Fig. 39.2).

a. The assistant and surgeon grasp the Tenon capsule less than 10 mm from the limbus.

b. Cut the Tenon capsule between the forceps and radially toward the limbus.

c. The incision should reach bare sclera. If layers of Tenon capsule remain, repeat steps 5a-b.

d. The incision should not extend more than 10 mm from the limbus or else orbital fat may be exposed and adherence syndrome may occur.

6. Isolate the lateral rectus with a Stevens hook.

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