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General aspects about how to start with MISS
- You need good surgical skills and surgico-anatomical knowledge before starting with MISS.
- Therefore, you should be skilled in open surgery before switching to MISS.
- Although you can perform MISS with magnifying glasses the use of a microscope is advocated.
- If you switch to a microscope first perform several procedures with your own technique before starting with MISS.
Your first patients
- Should be between 14 and 40 years in order to avoid abundant Tenon’s tissue or conjunctival tearing
- Start with primary horizontal rectus muscle displacements of 4 mm or less
- Perform rectus muscle marginal dissection (MADI) tucks instead of recessions to avoid unnecessary bleeding
- Use a corneolimbal traction suture for optimal visualization to avoid rubbing on the cornea
- Use small instuments to operate through MISS openings
- Large instruments reduce the visibility of the operating site and may tear the conjunctiva
- Don’t perform MISS transconjunctival suturing (TRASU) techniques, MISS reoperations, MISS in strongly restricted strabismus, MISS faden before being well accustomed with basic MISS techniques
Changes of dose-response relationships
- If MISS displacements are performed in the same way as before with open surgery, dose-response relationships will not change markedly
- Usually, tucks (plications), MADI tucks, and resections yield the same dose-response relationship
- Despite that, it is advisable to look for changes after switching to MISS
Read about MISS and visit a MISS surgeon
- Read about MISS publications, planned MISS talks, MISS courses and MISS wetlabs on the publication website
- Eye surgeons can contact us to visit a skilled MISS surgeon in his operating theater