Abstract
Purpose: To introduce an advanced muscle hook to decrease risks and create more feasible extraocular muscle surgeries for physicians. Case Report: Tight extraocular muscles during strabismus surgery could be extremely challenging even in experienced hands due to restricted globe rotation, limited view, and lack of muscle elasticity. Although a variety of surgical instruments have been introduced through the years, traditional muscle hooks such as the Jameson hook are largely unchanged and are bulky and cumbersome. Using the traditional muscle hook under situations such as pediatric strabismus surgery with smaller eyes and extraocular muscles may increase the risk of perforating the globe or even rupturing the muscles. We developed the “Suh muscle hook”, which has a 0.55 mm wide grooved track in a 1.1 mm wide horizontal bar, a semi-sharp dissecting tip, and a 30-degree bending near the handle accommodating for nasal bridge to better facilitate surgeons dealing with tight extraocular muscles and minimize risks during strabismus surgery.
Highlights
Numerous pathological conditions can give rise to tight extraocular muscles, including Graves’ disease, congenital fibrosis of extraocular muscles (CFEOM), previous strabismus surgery or retinal procedure, and traumatic scarring [1] [2]
Using the traditional muscle hook under situations such as pediatric strabismus surgery with smaller eyes and extraocular muscles may increase the risk of perforating the globe or even rupturing the muscles
We developed the “Suh muscle hook”, which has a 0.55 mm wide grooved track in a 1.1 mm wide horizontal bar, a semi-sharp dissecting tip, and a 30-degree bending near the handle accommodating for nasal bridge to better facilitate surgeons dealing with tight extraocular muscles and minimize risks during strabismus surgery
Summary
Numerous pathological conditions can give rise to tight extraocular muscles, including Graves’ disease, congenital fibrosis of extraocular muscles (CFEOM), previous strabismus surgery or retinal procedure (scleral buckle), and traumatic scarring [1] [2]. Surgical recession of tight extraocular muscle can be challenging due to restricted globe rotation which may prevent the optimal muscle exposure required for surgery [5]. Passing a needle anterior to the hook can be difficult due to the inability to stretch the taut muscle to provide enough space for the needle, which may result in additional resection or rupture of an already tight muscle [6] [7] [8]. Tight extraocular muscles often indent the globe and cause scleral thinning in that area [5]. Passing the needle posterior to the hook in the areas of scleral thinning could increase the risk of globe perforation [7] [8] [9]. A new grooved muscle hook, the Suh muscle hook, has been developed to minimize the perforation risk and improve the success rate of the surgery
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