ERICK BOTHUN: This is a medial rectus recession case. So we're going to grab infranasally and pull super temporally, make a snip in the fornix, and extend it nasally. Pull away and trim. Pull test is negative. Trim down on the tenons anterior to the muscle, just to disinsert it up front. And it allows it to be pulled back. Just cleaning out the muscle. You can do it with the little snips and trims. Partial thickness, exiting about a millimeter from the sclera, essentially the width of the small hook. And now coming back through, a full thickness bite. So we have lock bites on each end of the muscle.

So take the pull sutures, make sure we have-- it's not flipped over. We're going to do a hang back, so the muscle will be reattached at the original insertions. I try to do a cross sword's direction. Sutures, and I'll reattach the insertion. So now we're untying the suture allowing for a slack of 6 and 1/2 millimeters and tying over the needle holder. Then we are done with the medial rectus recession part of the case.

So you can see here, this is the rain FLEx, so you can see the reason you can't see the ring here is because of the dark pigment. So the goal will be to put the lens in the sulcus. I like to place a traction suture for intraocular procedures. It keeps the eye stabilized in certain situations, especially at the end of the case, if the child's getting light.

So if your primary wound is here, you can touch it and go across part of it. Secondary wound here. So then we'll do iris hooks in each of the four quadrants around. So I wouldn't go quite that deep. I would start with smaller bites of it. So reach in and just try to see if it's just anteriorly first.

So once you've established the anterior edge is open, then you can make a broader sweep to say, is there any more posterior adhesions in a more peripheral location. So I would probably start placing your hooks with a [INAUDIBLE] and your tuberculin syringe, 27-gauge needle marked. You'll go in, and all the way in, and it'll poke the iris. And that'll be fine.

So I would make a square. So I would aim a little bit at each corner, rectangular. The wounds are established. We're just going to place these hooks to open up the pupil. She has a small pupil. Once that step is done, we'll be able to evaluate what was left behind after the other location that did her cataract surgery.

Once the hooks are placed you'll be able to see what the lens structure looks like, or the capsular structure that will support the new lens. First thing we need to do is make sure there's no other adhesions. So I think we should just double-check. There's nothing here.

What matters the most when you capture is where they're coming off. Because that's the point where you need it to-- the capsule to go widest to. So this is already sort of an oval capsule. So the captics have to come off here and here.

So you can go down and get into the vitreous a little bit, and just take some time. There's vitreous right there. I actually think it's reasonable just to extend this side a little bit. So it's that art of getting the port far enough out that it's underneath tissue and it's not just the tip. The negative of having too small of opening when you capture is that you make it more oval.

All right, so we have the lens. Let's open the lens MA60, 23.5. Beautiful. All right let's load the lens. That's a nice-- and once it comes out, it's going to open. And then once it's released, you'll pull. Yep, and there it is.

So now the haptics are in the sulcus. It's really nicely centered. Your bag is supporting it. Your haptics are in the sulcus. And your eye wall is behind your axis. So we put the lens in the right place, tucked it in. It's sort of captured up and down. All right, we're just placing our last stitch. Beautiful. All done. Successful case debrief. Got the muscle done and the lens in.