ABSTRACT
PURPOSE: To evaluate success of nasal loop myopexy as a primary procedure in correcting the ocular deviation in primary position when combined with recession and resection procedure (R&R) in exotropia hypotropia complex in high myopia and to explore the probable cause for deviation. CASE REPORTS: We present a case series of three adult males with exotropia hypotropia complex and high myopia with large angle exotropia and hypotropia, with deflection of the courses of superior and medial recti seen intraoperatively. We performed a conventional recession and resection procedure, which was combined with a nasal loop myopexy between the superior rectus (SR) and medial rectus (MR) in the same session, under local anesthesia, to correct the deflected course of SR and MR; with the aim of correcting the deviation in primary position and improving ocular motility, mainly elevation in abduction. RESULTS: We present a case series of three adult males with exotropia hypotropia complex, who were operated between March 2017 and October 2017. In all the three cases described above, it was noted that the preoperative exotropia and hypotropia improved following the combination of nasal loop myopexy with a conventional recession and resection procedure, as shown by improvement in ocular deviation in the primary position (measured by prism bar cover test, PBCT). First patient improved from 50 prism exotropia with 16 prism hypotropia to 5 prisms exophoria and 6 prisms hypotropia in left eye. Second patient improved from 45 prism right exotropia and 10 prism hypotropia to 10 prisms exotropia and 6 prism hypotropia. Third patient improved from 40 prism left exotropia and 20 prisms hypotropia to 10 prism esotropia and 5 prisms hypotropia. Ocular motility showed no restriction following surgery in any of the gazes. Limitation of elevation in abduction, caused due to SR deflection, improved due to repositioning of SR and MR in their anatomical positions in all the cases. In the first patient elevation in abduction improved from -4 to -1; in the second and third patients, it improved from -2 to 0. None of the three adult patients experienced any side effects following the procedure. CONCLUSION: The combination of recession and resection procedures with nasal loop myopexy was found to be effective in correcting the ocular deviation and limitation to elevation in abduction by correcting the deflected course of superior rectus and medial rectus to result in an effective improvement of elevation in abduction. One case had an overcorrection of exotropia. There were no other major complications.
