PURPOSE: Rectus muscle plication is an alternative muscle-strengthening procedure to rectus muscle resection. Possible advantages of rectus muscle plication include a lower risk of "lost" muscles and anterior segment ischemia. METHODS: This was a retrospective case series describing a surgical procedure for rectus muscle plication using an adjustable suture technique that can be used on any of the four rectus muscles. RESULTS: A total of 5 adult patients underwent adjustable suture plication procedures. Of these, 2 patients required suture adjustment postoperatively. At the final follow-up visit, all the patients maintained satisfactory ocular alignment within 6(Δ) of orthotropia for horizontal deviations and 2(Δ) of orthotropia for vertical deviations. Diplopia was eliminated in all cases with preoperative diplopia. There were no postoperative complications or unexpected shifts in ocular alignment. CONCLUSIONS: Rectus muscle plication using this adjustable suture technique may serve as an alternative to rectus muscle resection and may be particularly useful in patients who are at risk for anterior segment ischemia or those in whom a shorter anesthesia time is recommended.