Guyton David L
The Krieger Children's Eye Center at Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-9028, USA.
Binocul Vis Strabismus Q. 2005;20(3):147-50.
One of Dr. Marshall Parks' most valuable contributions to strabology was his cul-de-sac ("fornix") approach to strabismus surgery. This approach provides better comfort, faster healing and less conjunctival scarring than previous approaches. Tearing of the conjunctiva can occur, however, especially in older patients with thin and friable conjunctival tissues.
To facilitate the cul-de-sc approach through a small incision, especially in older patients, I designed a new "small-incision" muscle hook.
A new sharp second bend combined with sharpening of the bend in the heel (creating literally an "S" bend) in the Jameson style eye muscle hook enables burying of the knee or heel of the hook in the wound, allowing reflection of the conjunctiva over the ball or toe of the hook without tearing. I have used and treasured this hook for over six years, routinely using the cul-de-sac approach to strabismus surgery in both children and adults.
This new small- incision muscle hook complements the cul-de-sac approach to strabismus surgery by allowing the use of a smaller incision while significantly decreasing the risk of conjunctival tearing.
马歇尔·帕克斯医生在斜视学领域最有价值的贡献之一是他的盲管（“穹窿”）斜视手术入路。与之前的手术入路相比，这种入路能带来更好的舒适度、更快的愈合速度以及更少的结膜瘢痕。然而，结膜撕裂可能会发生，尤其是在结膜组织薄且脆弱的老年患者中。
为了便于通过小切口采用盲管入路，特别是在老年患者中，我设计了一种新型“小切口”肌肉钩。
在詹姆森式眼肌钩上，一个新的尖锐第二弯曲与钩跟部弯曲的锐化（实际上形成一个“S”形弯曲）相结合，能使钩的膝部或跟部埋入伤口，从而在不撕裂的情况下将结膜覆盖在钩的球部或尖部上。我使用并珍视这个钩子已有六年多，在儿童和成人斜视手术中常规采用盲管入路。
这种新型小切口肌肉钩通过允许使用更小的切口，同时显著降低结膜撕裂的风险，对盲管斜视手术入路起到了补充作用。
