Augmented loop myopexy with concurrent intraocular lens implantation for myopic strabismus fixus

Purpose: To evaluate safety profile and surgical outcomes of loop myopexy with concurrent intra? ocular lens implantation in cases of myopic strabismus fixus (MSF). Methods: A retrospective chart review of patients who underwent loop myopexy with concurrent small incision cataract surgery with intra?ocular lens implantation between January 2017 and July 2021 for MSF at a tertiary eye care centre was undertaken. A minimum of 6 months of follow?up after surgery was required for inclusion. The main outcome measures were improvement in alignment postoperatively, improvement in extra?ocular motility postoperatively, intraoperative and postoperative complications and post?operative visual acuity. Results: 12 eyes of 7 patients (male (6): female (1)) underwent modified loop myopexy at a mean age of 46.86 years (range 32?65 years). 5 patients underwent bilateral loop myopexy with intra?ocular lens implantation whereas 2 patients underwent unilateral loop with intra?ocular lens implantation. All eyes underwent additional medial rectus (MR) recession with lateral rectus (LR) plication. At the last follow?up, mean esotropia improved to 16 prism dioptres (PD) (Range: 10?20 PD) from 80 PD (Range:60?90PD), P = 0.016; and success (deviation ?20PD) was achieved in 73% (95% CI 48 to 89%). Mean hypotropia at presentation was 10 PD (range 6?14 PD), which improved to 0 PD (range 0?9 PD), P = 0.063. Mean BCVA improved from 1.08 LogMar to 0.3 LogMar units. Conclusion: Loop myopexy combined with intra?ocular lens implantation is a safe and effective procedure in the management of patients who have Myopic Strabismus Fixus with visually significant cataract and improves both visual acuity and ocular alignment significantly.

Silicone band loop myopexy for myopic strabismus fixus

Myopic strabismus fixus causes inability of the eye to elevate and abduct in the setting of a myopic superotemporally herniated globe. We report a novel surgical technique to manage an 18-year-old male with myopic strabismus fixus. Radiological imaging demonstrated a nasally deviated superior rectus (SR) and inferiorly displaced lateral rectus (LR). Silicone band assisted myopexy of SR and LR was done along with anchoring them to the sclera with a dacron suture. The patient had satisfactory alignment postoperatively and did not require any intervention over 1-year follow-up.

A Case of Yokoyama Procedure in Myopic Strabismus Fixus

PURPOSE: To present a surgical result of Yokoyama procedure in myopic strabismus fixus. CASE SUMMARY: A 51-year-old female patient presented with progressive esotropia and diplopia. According to the Krimsky test, the patient showed 70 prism diopter esotropia and 30 prism diopter hypotropia in her left eye. The axial length was 34.97 mm in the right eye and 33.71 mm in the left eye. The patient was diagnosed with myopic strabismus fixus. The authors performed the Yokoyama procedure on her left eye. Surgical examination revealed each medial rectus muscle was recessed. Half of the muscle bellies of the superior and lateral rectus muscles were sutured together without muscle splitting 15 mm posterior from their insertion. At 1 year postoperatively, the patient showed 30 prism diopter esotropia and 20 prism diopter hypotropia in her right eye by alternative prism cover test. The authors performed the same procedure on her right eye. At 2 months after the second surgery, the patient showed orthotropia in the primary position and gaze limitation was improved. CONCLUSIONS: The Yokoyama procedure can be an effective method for improving deviation and ocular motility in esotropia caused by high myopia.

A Case of Rectus Muscle Transposition With Silicone Band in Strabismus Fixus With High Myopia

PURPOSE: To present a surgical result of rectus muscle transposition with silicone band without suture on the sclera in strabismus fixus with high myopia. CASE SUMMARY: A 73-year-old female patient with a 20-year history of bilateral esotropia and hypotropia visited our clinic. The patient`s right eye was aphakic because crystalline lens removal was performed 17 years earlier and the left eye was phthisical after retinal detachment, due to high myopia. Ocular movements in both eyes were severely restricted in all directions with the cornea barely visible. Ultrasound examination revealed posterior staphyloma of the retina. The axial length measurement was 32 mm in the right eye, and could not be measured in the left eye. Posterior tenon fixation of the medial rectus and inferior rectus muscle tendon was performed, in addition, fixation of the lateral half of the superior rectus and superior half of the lateral rectus muscle on the silicone band 10 mm posterior to each muscle's scleral insertion as a transposition procedure was performed. At 6 months postoperatively, there was no residual esotropia or hypotropia. The right eye maintained a gaze limitation but improved abduction and supraduction. CONCLUSIONS: In strabismus fixus with high myopia, posterior tenon fixation and muscle transposition with silicone band is an effective method without complication.

A Case of Surgical Repair For Convergent Strabismus Fixus with Bilateral Abducens Nerve Palsy

PURPOSE: We report a case in which a convergent strabismus fixus due to head trauma-induced bilateral abducens nerve palsy was successfully corrected. METHODS: A 45-year-old male patient who had bilateral,convergent strabismus fixus and limited eye movement because of bilateral abducens nerve palsy. A year previously, the patient had experienced a skull fracture and right facial nerve palsy caused by a traffic accident. At that time, the forced duction test revealed severe restriction of both eyes. The forced duction test still showed resistance after the right medial rectus muscle was disinserted. We made a conjunctival incision on the lateral canthal area and resected the right lateral rectus muscle. Then we performed lateral canthotomy, and fixed the lateral rectus muscle to the periosteum of the lateral orbital rim. When the left medial rectus muscle was disinserted, there was no resistance on the forced duction test. We then addressed the medial rectus muscle recession, superior and inferior rectus muscle transposition to the lateral rectus. RESULTS: Two years after the procedure, bilateral convergent strabismus fixus did not recur, even though right eyeball movement was impossible. Patient appeared an orthophoria at the primary position, and the cosmetic rersult was satisfactory.

A Case of Convergent Strabismus Fixus with Invisible Cornea

PURPOSE: We report an example of successful operation of rare convergent strabismus fixus, which had previously been mistaken for orbital tumor in private clinics because of severe adduction with unseen cornea. METHODS: A 57-year-old woman had convergent strabismus fixus with inward deviation of the left eye that had gradually progressed since she was around 40. Her cornea was buried in the intraorbital rim. An eye movement examination revealed that the eyeball was fixed to the internal part and that eyeball movement was impossible in all directions. When the forced duction test was performed, strong resistance was shown in all directions when abducted. During surgery, the medial rectus muscle was disinserted after resection of 3.0 mm for the left eye, and lateral rectus muscle tucking of 11.0 mm for the left eye was conducted. Since there was resistance in the inferior oblique muscle by the forced duction test during the operation, inferior oblique muscle myectomy of 4.0 mm was simultaneously performed. RESULTS: In the forced duction test implemented immediately after the operation, resistance subsided considerably and eye movement was shown in all directions, with cosmetically satisfactory results. Optic atrophy was found in the fundus examination after the operation. CONCLUSIONS: Convergent strabismus fixus, which recurs frequently and causes severe limitation of eye movement, was changed from the primary position to orthophoria by medial rectus muscle resection with disinsertion and lateral rectus muscle tucking. The eye movement disorder was improved and a satisfactory result was obtained.

A Case of Surgical Repair in Strabismus Fixus with Ptosis

Strabismus fixus is very rare and the convergent form is rarely accompanied by blepharoptosis. We successfully treated one patient with high myopia whose convergent strabismus fixus, accompanied by blepharoptosis, became severe after cataract surgery. We report the case with a discussion of its pathology. We performed levator advancement operation, bilateral lateral rectus 11 mm resection, and bilateral medial rectus 8 mm recession. The suture was removed after maintaining temporary traction suture for 6 days. Blepharoptosis was completely corrected by postoperative 2 months. Esodeviation was 15PD, which was not increased compared with immediately after surgery. Satisfactory cosmetic outcome was obtained.

Surgical Correction of Convergent Strabismus Fixus: A Case Report

PURPOSE: Strabismus fixus is a rare form of strabismus which is known for its difficulty to correct surgically, because it tends to go back to its previous state after the surgery. We report the case because we had successfully corrected the case of convergent strabismus fixus. SUBJECTS AND METHODS: A 38-year-old female patient who had both medial rectus muscle tenotomy 10 years before was operated with both lateral rectus muscle resection, superior and inferior rectus muscle recession and temporary traction suture for 5 days, but it was dissatisfactory, so making a hole in the lateral orbital rim was performed by microdrill, with fixation of insertion site of the lateral rectus muscle to the lateral orbital rim by permanent traction suture. RESULTS: At three months after the surgery, patient appeared to be almost orthophoric at primary position. Eye movement was impossible but we had satisfactory result cosmetically. CONCLUSION: It is suggested that eyeball fixation to lateral orbital rim is an effective surgical procedure for the case of convergent strabismus fixus which was not corrected by previous surgical techniques.

Divergent Strabismus Fixus

Strabismus fixus is a rare condition in which one or both eyes are anchored, as a rule, in a position of extreme adduction or abduction. The involved eye is "fixed" in this position and cannot be moved, and the forced duction test will confirm the immobility of the eye. The condition generally is thought to be congenital and caused by fibrosis, which would explain the loss of elasticity of the rectus muscle. Divergent forms of strabismus fixus not accompanied by ptosis or generalized fibrosis of the extraocular muscle are even more unusual. The authors experienced one case of divergent strabismus fixus in a 23 year old female patient. We performed complete disinsertion of both lateral rectus muscle and recession of conjunctiva and Tenon's capsule, combined with 11 mm resection of medial rectus muscle of left eye. The result of that surgery, however, was not satisfactory. So we performed 11 mm resection of medial rectus muscle of right eye and temporary fixation of the globes with traction sutures in a position of abbuction on both eyes at 3 days after the first surgery. After 4 weeks, patient was remained 60 delta exodeviation but primary position and ocular motility were improved.