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To the Editor.
—In retinal detachment surgery, we use an O black silk suture as a stay suture under each of the four rectus muscles. Normally, the surgeon ties a knot at the end of the suture. This makes the suture into somewhat of a loose ring when it is not held tautly. This can cause difficulty when the surgeon handles the suture, especially if he grasps only one arm of it. In this case, the suture will slip or slide and act as a loose ring under the muscle (Fig 1). Because of the slippage, it will be temporarily ineffective for holding the muscle.This situation can be avoided by tying an additional knot in the middle of the suture. This will prevent all slippage when the suture is grasped anywhere distal to the middle knot and will assure that neither of the arms of the suture will slip
Schatz H, Thier MD. An Additional Knot for Stay Sutures in Retinal Detachment Surgery. Arch Ophthalmol. 1978;96(3):543. doi:10.1001/archopht.1978.03910050301031