So this is a child who had inferior oblique recession on this side and then had inferior oblique anterior zation and transposition on the left side and she still had DVD in this eye and a little anti elevation because of the anti ization transposition we have found the previously recessed in fear oblique it’s always important to assess your technique.

When you’re going back on a muscle and this was a very beautifully operated upon muscle minimal scarring very nicely done you so we are now going to anterior eyes the muscle we’ve put a suture through it and we’ve dis inserted it from the globe and we’re once again.
When you put one muscle adjacent to another muscle you.

Go two millimeters away so that the muscles don’t scar together and.

Then we’re going to go three millimeters in.

Front of the original in this case I have the muscles in this direction so the sutures will go like this and like this on either side of.

That mark you have to be more careful.

You encounter a great deal of scar so you have to be very careful in your dissection if you find that a muscle is not appropriate for surgery go to another muscle and operate on it so for example if a muscle has had a myotomy it’s thinned and it might pull into so it may not be the best thing for the child to have that muscle operated on so always.
Go in with a plan a a plan B and a Plan C and.

Doctor here how important is it to make sure there’s no slack in the knot before you tie down that’s very very important because you change the surgery that you’re doing if you leave slack in it that’s very nicely approximated now and now the second knot is in place so it’s a square knot and now that insertion of the muscle.

Going to put one more in there and then we’ll so conjunctiva and then we’re done you.


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