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Chapter 7: Recession of a rectus muscle -  

Hang-back recession

Lecture 12 of 16  NEXT»


The hang-back recession has been described as "a simple, safe alternative to conventional recession." The procedure is said to be less likely to result in scleral perforation because needles are placed through relatively thicker sclera near the insertion site. Another reported safety factor is that because the suture placement site is more anterior, it is more accessible to the surgeon. Results are said to be comparable to conventional recession when appropriate doses are used. The attachment site has been shown to be about where it was intended on studies carried out on monkeys who had horizontal recti recessed with the hang-back technique. In humans who had hang-back recession of the superior rectus, reattachment 11.5 and 12.0 mm from the insertion (as intended by the surgeon) was confirmed by x-ray study of a stainless steel suture placed at the end of the superior rectus. Hang-back recession of the inferior rectus is likely to result in the complication of lower lid ptosis and muscle slippage. The inferior rectus muscle may be least suitable for hang-back recession, except in desperate cases as might occur in some cases of fibrosis syndrome and severe thyroid ophthalmopathy (Figure 25).

 

fig. 25

Figure 25
A Hang-back recession of the lateral rectus muscle through a cul-de-sac incision. 6-0 synthetic absorbable suture is used.
B The knot in the suture is pulled to bring the cut end of the muscle to the muscle stump. The suture is measured with calipers to determine the distance the muscle is recessed from the insertion.
C Sutures may be brought through the muscle stump at the width of the muscle. A limbal incision is used.
D The amount of ‘hang back’ recession is measured for the superior rectus.

 

 


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