Harada Ito Procedure
In this video we demonstrate the use of the Harada-Ito procedure for the correction of excyclotorsion associated with a superior oblique palsy. The left eye is viewed from its temporal aspect. The top of the eye is to the right and the bottom to the left.We begin with a small circumferential incision in the superotemporal quadrant adjacent to the temporal edge of the superior rectus muscle insertion . The incision is extended into the sub-Tenonís space using Westcott scissors. The superior rectus muscle is isolated on a Jameson muscle hook. The incision is enlarged and further dissection is carried until the reflected tendon of the superior oblique muscle is visualized. A second muscle hook is passed on the scleral surface, in a posterior direction, under the belly of the superior rectus muscle until the hook grasps the reflected tendon. The tendon is retracted in a temporal direction. It is easily identified because of its oblique orientation and its glistening appearance. The superior oblique tendon is then split longitudinally into anterior and posterior halves using Westcott scissors as well as muscle hooks. The anterior portion of the tendon is then secured using a double-armed 5-0 dacron suture, and this portion is disinserted from the globe. The lateral rectus muscle is isolated on a muscle hook and the eye retracted nasally. The tendon is advanced temporally and reinserted using partial thickness scleral bites above the superior border of the lateral rectus muscle and 7 mm from its insertion site. The conjunctiva is sutured using interrupted 6-0 vicryl sutures.