Dr. Ken Wright demonstrates a right Harada-Ito procedure. The technique displaces the anterior superior oblique tendon fibers temporally for the correction of excyclotorsion.

The superior rectus muscle is hooked, and the superior oblique tendon is identified and exposed. Dr. Wright uses Stevens hooks to grasp and tease out a third of the anterior tendon fibers and mobilize them. A 6-0 Vicryl suture is passed behind the fibers to maintain their position.

The lateral rectus muscle is then hooked, and both arms of the Vicryl suture are passed through the sclera 7 to 8 mm posterior to the lateral rectus insertion. Dr. Wright checks the location of the fovea to gauge how much extorsion will be corrected once the sutures are secured. He pulls up on the fibers and a simple single throw is placed. A bow tie knot is placed temporarily to hold the fibers while the surgeon re-examines the fundus for movement of the fovea. Satisfied with the outcome, Dr. Wright secures the scleral suture in place. The intermuscular septum and conjunctiva are each closed with 6-0 plain gut sutures. Video adapted from Pediatric Ophthalmology and Strabismus (Oxford University Press, 2012).