Erick D. Bothun, M.D., is a pediatric ophthalmologist and strabismologist at Mayo Clinic in Rochester, Minnesota. Dr. Bothun performs a recession on the medial muscle for crossing in a child's eye that had a congenital cataract. The cataract had been removed several years ago, but Dr. Bothun inserts a new intraocular lens to help with vision.
This is a medial rectus recession case, so we're gonna grab in for nasal and pull super temporally. Make a snip in the for nix and extend it easily. Pull away and trim pole test is negative, trim down on the teen ins and tear the muscle just disconcerted upfront and allows it to be pulled back. Just cleaning out the muscle. You can do it with a little snips and trims partial thickness, exiting about a millimeter from the square are essentially the width of the small hook coming back through a full thickness bite. So we have locked bytes on each end of the muscle. So take the pole sutures. Make sure we have, it's not flipped over, We're gonna do a hang back so the muscle be reattached at the original insertions. I try to do a cross swords direction sutures are already attached to the insertion. So now we're gonna tie in the future, allowing for a slack of 6.5 millimeters and tying over the needle holder. Then we are done with the medial rectus recession part of the case. So you can see here, this is the rain flex, you can see the reason you can't see the ring here is because of the dark pigment. So the goal will be to put the lens in the sulcus. I'd like to place attraction suture for inter ocular procedures. It keeps the ice stabilized in certain situations, especially at the end of the case if the child is getting light. So if your primary ones here, you can touch it, go across part of it. Secondary wound here. So then we'll do irish hooks on each of the four quadrants around. So I wouldn't go quite that deep. I would start smaller bites of it so reach in and just try to see if it's just anti really first. So once you've established the anterior edges open, Then you can make a broader suite to say, is there any more poster adhesions? One more peripheral location? So I would probably start placing your hooks with a calibri and your tuberculosis orange 27 gauge needle mark you go in and all the way in and it'll poke the iris and that'll be fine. I would kind of make a square. So your I would aim a little bit, you know, each corner, rectangular. The wounds are established. We're just gonna place these hooks to open up the pupil. She is a small pupil. Once that step is done, we'll be able to evaluate what was left behind after the other location that did our cataract surgery. Once the hooks are placed, we'll be able to see what the lens structure looks like or the capsule structure that will support the new lens. First thing we need to do is make sure there's no other adhesions. So I think we should just double check there's nothing here. What matters the most when you capture is where they're coming off because that's the point where you need to get the capsule go wide as two. So this is already sort of an oval capsule. So the captains have to come off here and here So you can go down and get into the vitreous a little bit and just take some time there's interest right there. I actually think it's reasonable is to extend this side a little bit. So it's the art of getting support far enough out that it's underneath tissue. And it's not just the tip. The negative of having too small of opening when you capture. Is that you make it more oval. Alright, so we have the lens. Let's open the lens. M.A. 23.5. Beautiful. All right. Let's load the lens. That's a nice and once it comes out it's gonna open and then once it's released you pull and there it is. So now the haptics are in the circus. It's really nicely centered your bags supporting it. Your haptics are in the circus and your Iowa is behind your exes. So we put the lens in the right place tucked it in. It's sort of captured up and down. Alright. We're just placing our lasted beautiful. All done, successful case debrief got the muscle done and the lens in
