MALE SPEAKER: All right, so strabismus repair is about restoring alignment. But when they've had many surgeries before there's commonly scarring and abnormalities and muscle position from prior surgeries. You can see he's had surgery somewhat recently and has had multiple areas of thickening. Both later recti have been operated on before. So commonly in a case like this you start with forced duction testing.

You want to see if there's a range, his eyes obviously pull out well. He has a drift out exotropia in the first place. And my approach for lots of strabismus cases is to mark the conj first, cut down, let's just go right across. And so I'm going to hook from above. Let's do half the muscle at a time. So we've cleaned off the lateral, you can see it.

Nice fibers going posteriorly, I do a partial thickness pass. All right so we have half the muscle isolated and now we're going to go the other way. So you get a lock bite on each side. Some people put two lock bites, I just typically do one.

So now we have the muscle on the sutures. So we've just taken the lateral off. All right and then we can take that back out and then we'll pull the conj back forward. 8 o vicryl. So we've done a lateral rectus recession on this fellow eye. Now we're turning to the right side.

We're going to go explore and do the same thing here. So muscle's isolated, we know we're going to recess it. So here's the partial thickness pass going inferiorly. And then at the inferior pull of the later rectus muscle will put a knot. So difficulty with exposure, trying to get the lateral, but now the lateral is off the eye.

Why don't you do forced duction testing? We're reattaching the muscle at a certain millimeter behind, a certain distance behind where it started. In this case, it's 14 millimeters behind the normal anatomical position. So we're way back on the eye. Now the eye, lateral rectus muscle is reattached to the eye further back, but I do think we need more.

So let's just do a little quick resection of the medial. And then we're going to do just a dissect spreading and trimming. All right so let's go ahead and imbricate it to allow for a resection. The insertion is on the front hook, I'm stretching out the back hook, I mark across the back. So you're going to pass your first partial thickness pass.

Yep, and then a full thickness coming back for the lock bite. So here's the partial thickness, so the lower half is secure on an imbricated bite of the muscle. And now we're going to do the superior pole. Beautiful. So we're trimming the muscle off and then we'll cauterize that stump. The anterior resected muscles right here.

So we're going to lift that up with a forcep and take it off the eye. So let's reattach it here and here. So we have just resected this medial and further improving this gentleman's alignment. So he started out at the beginning of the case with eyes drifted out, if anything right now they're closer a little bit in, which is great.

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