Tips and Tricks for Retrieval of a Lost Muscle

Dr. Savleen Kaur and colleagues demonstrate retrieval and reattachment of the medial rectus, which detached when the Retina Fellow forcefully manipulated a globe that felt tense following injection of additional anesthesia. While performing a pars plana vitrectomy on a 64-year old patient with aphakic rhegmatogenous retinal detachment, the surgeons called upon a strabismologist who concluded that the medial rectus had snapped behind its insertion. The search for the muscle began with reviewing the surrounding anatomy and focusing on the assumption that the muscle retracted toward its origin located deep in the orbit. The strabismologist performed dissection along the periosteum and then toward the orbital apex and found the muscle in the subtenon space along the orbital wall. The strabismologist reattached the muscle avoiding dissection along the lines of the globe which could push the muscle farther back. After muscle reattachment, the vitrectomy surgery was resumed. 

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