Suture loop myopexy versus silicone band loop myopexy in the management of myopic strabismus fixus

Abstract

To compare two different modalities of superior rectus-lateral rectus loop myopexy; suture (SLM) and silicone band loop (SBM), in the treatment of myopic strabismus fixus. The medical records of patients with myopic strabismus fixus who underwent surgical management with either SLM or SBM at a single institution over a period of 4years were retrospectively reviewed. In cases with positive intraoperative forced duction test, the medial rectus muscle was recessed. The primary outcome measures were improvement of primary position esotropia, hypotropia, and limitations of abduction and elevation. The angle between the displaced superior rectus and lateral rectus muscles (angle of globe dislocation) was also assessed by orbital imaging before and after surgery. A total of 21 patients were identified, of whom 10 underwent SLM and 11 underwent SBM. Mean age at surgery was 65.4±5.7years in the SLM group and 68.5±6.4years in the SBM group. Both procedures significantly improved esotropia, hypotropia, angle of globe dislocation, and limitation of abduction and elevation (P<0.0001), with no significant statistical difference between procedures (P>0.05). Intraoperative muscle splitting occurred in 2 cases in the SLM group, and transient foreign body sensation was documented in 3 cases in the SBM group. In this study cohort, both techniques achieved significant correction of ocular deviation, limitation of ocular ductions, and angle of globe dislocation associated with myopic strabismus fixus, with no statistically significant difference between procedures. Operative complications in both groups were mild and innocuous.