Silicone Band Loop Myopexy for Strabismus Fixus in Heavy Eye Syndrome, Highly Myopic Sagging Eye Syndrome, and Sagging Eye Syndrome

Purpose: To report the surgical outcomes of silicone band loop myopexy in patients with strabismus fixus associated with heavy eye syndrome (HES), highly myopic sagging eye syndrome (SES), and SES. Methods: This retrospective case series included 8 patients with strabismus fixus who underwent loop myopexy between the lateral rectus (LR) and superior rectus (SR) muscles using a type 240 silicone band. Diagnoses of HES, highly myopic SES, and SES were defined based on clinical and radiologic findings. Demographic and clinical data, including axial length, the LR-SR angle on coronal orbital CT (computed tomography) imaging, and additional surgical procedures, were reviewed. Results: A total of 11 eyes were included: 7 with HES, 1 with highly myopic SES, and 3 with SES. Axial length ranged from 27.50 to 32.38 mm in HES, was 32.06 mm in the highly myopic SES eye, and ranged from 23.32 to 23.61 mm in SES. The LR-SR angle ranged from 135° to 170° in HES, was 120° in the highly myopic SES eye, and ranged from 115° to 130° in SES. Preoperative esotropia ranged from 70 to over 100 prism diopters (PD) and hypotropia from 10 to 50 PD, with marked abduction limitation and variable supraduction limitation. Postoperatively, all patients were aligned within 20 PD of esotropia with full abduction and supraduction. Medial rectus recession was additionally performed in all cases. Conclusions: Silicone band loop myopexy combined with medial rectus recession was associated with favorable postoperative alignment and motility outcomes in strabismus fixus related to LR-SR region pathology, including HES, highly myopic SES, and SES.