Erick D. Bothun, M.D., is a pediatric ophthalmologist and strabismologist at Mayo Clinic in Rochester, Minnesota. Dr. Bothun performs a strabismus surgery using a classic limbal approach with medial rectus recession. Dr. Bothun uses hang-back recession with adjustable suture on the second eye in this procedure. So I like to mark up the content Eva this is such a little thin lacy stuff. Great. So classic limbo approach, make a relaxing decision and then as a rule of thumb that we don't we're not going to touch things in this will protect the flap so you spread on each side by going outside of the flap. So we hooked the media rectus. So just gently I kind of do one side of the muscle at a time. I always I'm a little cautious using a Q tip dissection here. Alright, so we're gonna recess this double and bankroll. You can take it all the way off because we're gonna open, conjure a limbo approach. Nice small bites again, always bringing that back blade forward first and then the front blade back to it. Great. So I typically like to attach this muscles back to their insertion at approximately 5.5 millimeters. You can get wider. 5.5 6. Great. Okay so now we'll go ahead and do the same procedure, do a limbo opening and a media rectus recession on the left eye. So now hook the medial pull straight towards you. Large hook. Now we got it all a small recession like we're doing you don't need to trim very much. Yeah, so muscles exposed and we will implicate. So there's a little plaque here I think and the start of an early plaque. So this past will have two more come forward. This past will see as you go into it even that might be calcified. So in this i we're setting the muscle to this clara and having a knot that has what's called a noose and adjustable noose. The knot is tied. Now you take a, take a tires and cinch that book. We need to sense the top one more than the bottom one. There we go. That's good. That's good. Let's try to limit the Lord. Nice. Let's just trim this right here. It's just a little bit of a tricky um there. Yeah.