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    AAO 2019 Video Program
    Pediatric Ophth/Strabismus, Strabismus

    In this surgical video, we demonstrate adjustable medial transposition of split lateral muscle using four fornix conjunctival incisions, one in each quadrant. Posterior tenectomy of superior oblique is done to tackle its unopposed overaction and facilitate the transposition. Superior slip of the lateral rectus is passed under the superior oblique remnant and superior rectus, and inferior slip is passed under inferior oblique and inferior rectus. Both slips of muscle are then passed under the medial rectus and inserted on the nasal sclera in a crossed action manner, using short-tag noose adjustable technique, to facilitate postoperative adjustment. Either or both of the two slips may be adjusted in the postoperative period, depending on the vertical and horizontal alignment achieved. The crossed insertion provides a larger abducting force and more room for advancement of the lateral rectus slips, as compared to a conventional uncrossed insertion. Good immediate and long-term alignment was achieved with this technique.