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    Medial Rectus Advancement in Stretched Scar

    By Kenneth W. Wright, MD
    Pediatric Ophth/Strabismus

    Dr. Ken Wright demonstrates advancement of the medial rectus muscle in a case of consecutive exotropia due to a stretched muscle attachment scar. The conjunctiva is dissected and the medial rectus is brought into the surgical field with a Jameson hook. The intermuscular septum is opened and scar tissue is removed. As no true muscle is evident, Dr. Wright continues dissection posteriorly to expose the rectus muscle. The muscle is secured with a 5-0 Vicryl suture and locking bites are placed on the edge of either side. After the scar is excised, the muscle is advanced to the tendon insertion point, 7 mm posterior to the limbus, and reattached with intrascleral sutures. To help prevent recurrence of a stretched scar, Dr. Wright places a permanent 5-0 nonabsorbable suture through the sclera and muscle edge. Video adapted from Pediatric Ophthalmology and Strabismus (Oxford University Press, 2012).