Fig. 4. A. Double-armed sutures are placed in the scleral covering of the implant in the areas where the medial and lateral recti would be if the implant were a small globe. A central, apical, double-armed suture also is placed. B. The implant sutures are passed through posterior Tenon's fascia and tied. The apical suture imbricates the lips of posterior Tenon's fascia. C. Conjunctiva is now undermined from anterior Tenon's fascia. The sutures tagging the horizontal recti muscles are passed through anterior Tenon's fascia and conjunctiva and tied in the fornices. D. Anterior Tenon's fascia is imbricated and conjunctiva is closed.