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.

The art of tackling strabismus skillfully by sparing vessels

Background: Detaching a rectus muscle irreparably destroys its ciliary artery circulation which also supplies the anterior segment of the eye. Purpose: To educate strabismus surgeons about a method of detaching a muscle without compromising anterior segment circulation. Synopsis: A limbal based conjunctival incision is made. The muscle is identified, separated from its attachments and secured with 6-0 Vicryl. The anterior ciliary vessel supplying it is isolated by making a small snip incision in the muscle capsule with delicate blunt dissection parallel to the anterior ciliary artery The muscle is detached from its original insertion. The muscle is tied to sclera at the intended point of recession. The intact anterior ciliary artery, thus will continue to function, untouched. Highlights: We recommend pre-placing the sutures in the muscle and also in the sclera at the point of reattachment to avoid possible stretching and breaking of anterior ciliary vessels at the time of muscle detachment and also to dissect the artery free from muscle several millimeters more than the intended recession in order to spare the anterior ciliary circulation in strabismus surgery.