MMCR with externalization of suture knots
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This is Richard Allen at the University of Iowa.
This video demonstrates a Muller muscle – conjunctival resection (MMCR) with externalization of the suture.
The upper eyelid is everted over a Desmarres retractor. The superior border of the tarsus is marked with the monopolar cautery. A 9 mm resection is going to be performed; therefore, additional markings are made 4.5 mm superior to the previous markings. In this case, a 6-0 silk suture is placed in a running fashion along the superior markings in order to provide traction. The Putterman clamp is then placed to the superior edge of the tarsus and tightened. Externalization of the suture is performed in this case to obviate the use of a contact lens. The suture is a 6-0 chromic suture and placed full thickness through the eyelid to exit medially at the superior border of the tarsus. The suture is then tied to itself externally. The suture is then placed in a running mattress fashion along the superior border of the tarsus. This is placed along the edge of the Putterman clamp. The suture is then placed full thickness through the eyelid laterally. The suture is then tied to itself laterally at an appropriate tension. A 15 blade is then used to incise the conjunctival and Mullers muscle at the edge of the Putterman clamp. This is performed in a "metal on metal" fashion to prevent cutting the suture. At the conclusion of the case, ophthalmic antibiotic ointment is placed into the eye three times per day, and the patient will return in approximately one week for reevaluation.