Treatment of "heavy eye syndrome" using simple loop myopexy.

PURPOSE: To describe our results using a technique modified from that described by Yokoyama in 1991 for treating heavy eye syndrome with high myopia by restoring the normal anatomical relationship of superior rectus and lateral rectus. We perform a simple loop myopexy between superior rectus and lateral rectus without concurrent muscle splitting, medial rectus recession, or scleral fixation. METHODS: Retrospective analysis of records of all patients with heavy eye syndrome who underwent our modified simple loop myopexy procedure between 2005 and 2008. Pre- and postoperative orthoptic measurements were recorded and analyzed. Surgical complications were noted. Success was deemed patient satisfaction. RESULTS: A total of 5 patients were identified who underwent the procedure for heavy eye syndrome. All patients requested surgery for aesthetically unacceptable strabismus. The mean preoperative horizontal deviation was 13(Delta) esotropia and the mean vertical deviation was 21.8(Delta) hypotropia. The mean postoperative horizontal deviation was 0(Delta) and vertical deviation was 4.4(Delta) hypotropia. Thus there were large improvements in both the vertical (17.4(Delta)) and the horizontal deviations (13(Delta)) following surgery. There were no surgical complications. Follow-up was 6 months. All patients have aesthetically acceptable deviations and have been discharged from care. CONCLUSIONS: A simple loop myopexy can be an effective treatment in these difficult patients. We encourage a staged approach to these patients, with simple myopexy being the first line of approach.

The psychosocial aspects of strabismus: correlation between the AS-20 and DAS59 quality-of-life questionnaires.

PURPOSE: To compare two quality-of-life (QoL) scales and subscales: the Derriford Appearance Scale 59 (DAS59) and the Adult Strabismus-20 (AS-20) scale in a series of strabismic and nonstrabismic patients and to illustrate the differences in results between strabismic and nonstrabismic patients. METHODS: The DAS59 is a self-report QoL questionnaire generating an assessment of distress caused by problems of appearance. The AS-20 is a newly developed strabismus specific QoL scale. A prospective, noninterventional study of a series of consecutive adult patients undergoing strabismus surgery and a control group was performed. Patients were given both questionnaires to complete before surgery. The underlying condition, previous number of surgeries, and deviation measurements were recorded. RESULTS: Thirty-four patients and 30 controls correctly completed both questionnaires. In the strabismus group, the mean AS-20 score was 50.5. The mean DAS59 score was 122.5 (out of 269). There is strong correlation between the scales (r = -0.813; 95% CI, -0.90 to -0.66; p < 0.0001). In the control group, the AS-20 score was 98.8 and the DAS59, 84.4, with both showing significant differences to the strabismic group (t = 12.9 [p < 0.0001] and t = -4.642 [p < 0.0001], respectively). CONCLUSIONS: The AS-20 shows strong correlation to the widely used DAS59. Strabismus patients show significantly more psychosocial distress than controls. The AS-20 is specific to strabismus patients and the result is not influenced by any other systemic factors that can impinge on the more general DAS59 scale.