Erick D. Bothun, M.D., is a pediatric ophthalmologist and strabismologist at Mayo Clinic in Rochester, Minnesota. In this case, Dr. Bothun successfully recesses both medial recti with adjustable suture on the right eye. Dr. Bothun demonstrates two different reattachment techniques in this strabismus case of esotropia. So this is a strabismus case of ece Tropea and we're going to assess both medial rectus muscles, I'm gonna make a classic for Nick's wound About eight back. So I hooked the medial rectus. I try not to have the point come forward. So now the muscles nicely exposed. There's really not much tenants to speak of and we'll go ahead and implicate the muscle. Always when you trim a muscle off in for neck surgery, you trim towards the wound and then we'll re attempt the muscle nice and slow control passed to get that five millimeter insertion recession double pass. Here's the next one blocking way or in a square. Not fashion if the wound doesn't want to close completely, you can lift up on its edge and get this must get it too close. If there's any concern about gaping, you can always put a NATO vicryl on the other side. We're gonna reattach in a slightly different way with with what's called an adjustable suture and this is a radio wound extending from the limbless towards the car. Uncle just inferior to the medial rectus and then you hook the medial rectus. Now that we've isolated the muscle, I can go ahead and indicate through that radial for Nick's wound. Now we have a muscle that's implicated and we're cutting towards the for Nick's wound in fairly. So in the same way I can go in and trim off the rest of this muscle and here is where we deviate from the last case as performed in a hang back technique we suture. An adjustable news. Typically at the insertion same thing here some pressing down going straight ahead. If I get thin I can push down can continue that plane and exit using my small hook if I'd like. And I'm setting that by placing this suture these locked. Excuse me setting the poles sutures and securing them to each other. At this point we want to recess this muscle with an adjustable news at this point where you're going to put the noose in place and we're ready to close the eye with a couple of micro sutures and I'll do that now before the case is completed. So that is a radio for nick's wound. And you'll see here how nicely that comes together for potential adjustment tomorrow. Not at the end of the case. And we have successfully recessed both. Media director with adjustable on the right, okay.