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Oak Park Surgery Center
860 Oak Park Blvd., Suite 102
Arroyo Grande, CA 94320 ♦ (805) 474-6383
OPERATIVE REPORT
PATIENT NAME:
MEDICAL RECORD NUMBER:
DATE OF SURGERY:
WILLIAMS, GAVIN
0018282
June 02, 2016
SURGEON:
ASSISTANT:
ANESTHESIOLOGIST:
ANESTHESIA:
ADAM D. ABROMS, M.D.
NONE
NOLAN HIGA, M.D.
GENERAL
PREOPERATIVE DIAGNOSES:
1. Congenital oculomotor palsy, Left Eye.
2. Extreme monocular exotropia, Left Eye.
3. Status post prior strabismus surgery, Left Eye.
POSTOPERATIVE DIAGNOSES:
1. Congenital oculomotor palsy, Left Eye.
2. Extreme monocular exotropia, Left Eye.
3. Status post prior strabismus surgery, Left Eye.
OPERATIVE PROCEDURES:
1. Hummelsheim transposition with Foster modification, Left Eye.
2. Strabismus surgery in setting of prior extraocular muscle surgery involving maximal
resection and recession procedure of Left medial and Left lateral recti muscles, Left
Eye.
3. Examination under general anesthesia, Left Eye, with forced duction testing.
ESTIMATED BLOOD LOSS: 20 cc.
COMPLICATIONS: None.
PROCEDURE PERFORMED: The patient was brought to the operating suite where general
anesthesia was induced. The patient was prepped and draped in the usual sterile manner for
strabismus surgery. The lid speculum was placed in the left eye. An examination under general
anesthesia was performed with loupe magnification and fiber optic illumination. Forced duction
testing was then performed on the left eye and revealed that there was not significant restriction
to adduction of the left eye.
An inferonasal conjunctival fornix incision was created with scissors and carried through anterior
Tenon’s fascia down to bare sclera. The left medial rectus was isolated on serial muscle hooks
and cleaned of adjacent scar tissue involving the overlying conjunctiva and Tenon’s capsule and
underlying sclera. The muscle was then released. Through the same inferonasal conjunctiva
fornix incision, the left inferior rectus was then isolated with serial muscle hooks and cleaned of
its anterior fascial attachments with sharp dissection.
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Oak Park Surgery Center
860 Oak Park Blvd., Suite 102
Arroyo Grande, CA 94320 ♦ (805) 474-6383
OPERATIVE REPORT
PATIENT NAME:
MEDICAL RECORD NUMBER:
DATE OF SURGERY:
WILLIAMS, GAVIN
0018282
June 02, 2016
A 6-0 Vicryl double-armed S-29 suture was woven through the left inferior rectus with locking
ties at either edge. The sutures were taped to the drape and the muscle was released. A
second superonasal conjunctival fornix incision was then created on the left eye with scissors
and carried through anterior Tenon’s fascia down to bare sclera. The left superior rectus was
then isolated and sutured in a manner identical to that of the left inferior rectus. The left medial
rectus was then again hooked through the inferonasal conjunctival incision. The left inferior
rectus was then reattached with sclera with its nasal pole suture immediately adjacent to the
superior pole of the medial rectus, and both sutures were passed intrasclerally in standard
crossed-swords manner to place the superior rectus in line with the medial rectus,
approximately equidistant from the corneal limbus. The muscle was tied securely at this
location. Similarly, the left superior rectus was anteriorly transposed to the superior border of
the left medial rectus muscle and sutured securely. It was clear that there was not adequate
adduction of the left eye following this procedure alone, and therefore a Foster modification was
applied to adjust the amount of adduction. This involved using a 5-0 Mersilene suture, which
was passed through the inferior one-quarter of the transposed superior rectus muscle, 8.0 mm
posterior to the insertion. The suture was then passed intrasclerally at the superior border of
the left medial rectus, and the muscle was tied securely at this location. Similarly, the 5-0
Mersilene suture was passed at the same position in the left inferior rectus, 8.0 mm posterior to
its insertion and through the superior quarter of the muscle. This was also attached securely
with an intrascleral pass at the inferior border of the left medial rectus. This muscle was also
tied securely in this position. Conjunctiva was then closed with interrupted 6-0 Vicryl suture.
At conclusion of surgery, all drapes and instrumentation were removed. Betadine 5% solution,
and Ofloxacin ophthalmic drops, and Xylocaine 2% gel were applied to the left eye. The patient
emerged from anesthesia uneventfully and left the operating room in stable condition.
_________________________
Adam D. Abroms, M.D.
AA/mes
D: 06/02/16
T: 06/03/16
Tracking #: WS365517
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