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Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 217-218  

Stiffened hang-back: A suggested modification using cyanoacrylate glue

Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India

Date of Web Publication20-Nov-2015

Correspondence Address:
Prof. Abadan K Amitava
Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh - 202 002, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-620X.169900

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How to cite this article:
Amitava AK, Grover S, Kumari N. Stiffened hang-back: A suggested modification using cyanoacrylate glue. Oman J Ophthalmol 2015;8:217-8

How to cite this URL:
Amitava AK, Grover S, Kumari N. Stiffened hang-back: A suggested modification using cyanoacrylate glue. Oman J Ophthalmol [serial online] 2015 [cited 2023 Jan 28];8:217-8. Available from: https://www.ojoonline.org/text.asp?2015/8/3/217/169900


We are sharing our experiment on the use of cyanoacrylate glue in an attempt to prevent the central sag of the muscle edge, a common finding during hang-back recessions.

First introduced by Repka and Guyton, hang-back recessions have been performed for several years as an alternative to conventional strabismus surgery.[1] The hang-back technique is most useful in cases of combined strabismus and retinal detachment surgery, those with risk of scleral perforation such as high myopia and other cases with the thin sclera. Hang-back may be especially useful in children with small globes, where it may be difficult to make a posterior scleral pass in case of large recessions.[2] It is also less time consuming. However, a major problem noticed, is the posterior bowing of the muscle that may lead to overcorrection, with this in mind and considering the increasing use of cyanoacrylate glue in ophthalmology, we thought of using this glue to avoid sagging of the muscle. Cyanoacrylate has been used as an effective, safe and bio-tolerant alternative to sutures for re-attaching rectus muscles in recession surgeries. Studies have shown that the muscle-sclera bond achieved using cyanoacrylate can withstand loads far more than the maximum force of 75 g generated by the human extra-ocular muscles.[3],[4] Cyanoacrylates need minimal hydration to polymerize. The tensile strength of the bond is highest of all glues.[5],[6] They form a solid impermeable mass in situ, a property, which can be used to advantage to stiffen the muscle edge and prevent sagging as we demonstrated in animal eyes. We exposed the rectus muscle of a goat's eye. Prior to dis-insertion, we secured the muscle with a 6–0 double armed Vicryl suture: A single bite through the center, and two locking bites through the edges. The 6–0 Vicryl sutures were passed through the insertion stump, and the edge allowed to hang-back [Figure 1]. At the posterior edge of the muscle increasing traction was applied using gradually increasing weights, up to 50 g over a pulley arrangement to mimic the pulling forces.
Figure 1: Hang-back technique, note the posterior bowing of the muscle edge

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In the second eye, a similar procedure was carried out, except for applying a strip of iso-amyl-cyanoacrylate (IAC) glue to the dis-inserted muscle edge and allowing 45 s for the glue to polymerize and stiffen [Figure 2].
Figure 2: Iso-amyl-cyanoacrylate glue applied to the cut edge of the muscle, there is no central sag and the muscle edge appears straight

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We found that the muscle edge with the IAC continued to maintain its stiffness and resisted deformation for up to 4 h under a continuous strain of 50 g force.

We are of the opinion that IAC stiffened hang-back recessions will prevent the muscle edge from sagging during muscle-scleral "take," and thus prevent possible overcorrection. We also believe that the stiffened muscle edge may not favor forward migration to reattach on the sclera, decreasing the possibility of significant under correction. Undoubtedly, this idea needs to be confirmed in a clinical environment.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Repka MX, Guyton DL. Comparison of hang-back medial rectus recession with conventional recession. Ophthalmology 1988;95:782-7.  Back to cited text no. 1
Wright KW. Rectus muscle recession. In: Farzavandi S, editor. Color Atlas of Strabismus Surgery, Strategies and Techniques. 3rd ed. New York: Springer Science Publishers; 2007. p. 128.  Back to cited text no. 2
Darakshan A, Amitava AK. Cut and paste: A novel method of re-attaching rectus muscles with cyanoacrylate during recessions in strabismus. Indian J Ophthalmol 2010;58:395-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
Bona MD, Arthur BW. Cyanoacrylate tissue adhesive on a polyglactin scaffold in strabismus surgery: A laboratory study. J AAPOS 2014;18:21-5.  Back to cited text no. 4
Mattick A. Use of tissue adhesives in the management of paediatric lacerations. Emerg Med J 2002;19:382-5.  Back to cited text no. 5
Vyas S, Kamdar S, Vyas P. Tissue adhesives in ophthalmology. J Clin Ophthalmol Res 2013;1:107-12.  Back to cited text no. 6
  Medknow Journal  


  [Figure 1], [Figure 2]

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