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2014 postgrad course of SLMC at Global City, discussion on conjunctival incision and closure, as well as, securing rectus muscle on the sclera
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Strabismus SurgeryAlvina Pauline D. Santiago, MD
Pediatric Ophthalmology and Strabismus
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SLMC PostGrad Course 2014
Conjunctival Opening
Fornix
Limbal
Paralimbal
Variations
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Modification: “7” paralimbal incision
1 mm paralimbal
Relaxing incision in the superotemporal or superonasal quadrant
Hidden from “oglers” because of Bell phenomenon
1 less relaxing incisionFells, P. BJO 1971 &
Santiago AP et al, Ophthalmic Surg Lasers 1998
Fig from Sami D, 2007
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Modified Paralimbal “7”-incision4
Caputo’s one snipworks best for medial rectus
Caputo AR, Guo S, DeRespinis P, et al. Simplified limbal incision for extraocular rectus muscle surgery. Ophthalmic Surg 1991; 22: 406-408.
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Fig from Sami D, 2007
Anchoring Muscle
Parks Crossed Swords
Simple Anchoring to Sclera
Hangback
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Anchoring Muscle: Resection
anchored to muscle stump
anchored to scleral insertion
muscle thinnest at insertion
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Fig from Rosenbaum & Santiago, 1999
Conjunctival Closure!
Anatomic Closure
Recess Conjunctiva
Glue (fibrin) Guo S, Wagner RS, Forbes BJ et al. Sutureless conjunctival closure. JPOS 2010: 47 (4) 228-230.
less inflammation, less discomfort
Reduced surgery time, less anaesthesia
Held well
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Fig from Rosenbaum & Santiago, 1999
ReferencesCaputo AR, Guo S, DeRespinis P, et al. Simplified limbal incision for extraocular rectus muscle surgery. Ophthalmic Surg 1991; 22: 406-408.
Guo S, Wagner RS, Forbes BJ et al. Sutureless conjunctival closure. J Pediatr Ophthalmol Strabismus 2010: 47 (4) 228-230.
Rosenbaum AL, Santiago AP. Clinical Strabismus Management, Principles and Technique. Elsevier 1999.
Sami DA. Conjunctival incisions for strabismus surgery: a comparison of techniques. Techniques in Ophthalmology 2007; 5(3): 125-129.
Santiago AP, Isenberg S, Neumann D, et al. The paralimbal approach with deferred conjunctival suture for adjustable Strabismus Surgery. Ophthalmic Surg Lasers 1998; 29: 151-156.
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Thank you!