Securing extraocular muscles in strabismus surgery: biomechanical analysis of knot-tying technique

Proper cinching or minor modification of the first knot throw provides excellent tensile strength, even with short, widely spaced scleral tunnels, comparable to that achieved with the technically more demanding crossed swords technique. Conventional, noncinched first throws are prone to slip at low force when scleral tunnels are widely separated, though the resistance increases as the number of loops increases.