Surgical correction of an inferiorly displaced lateral rectus with equatorial myopexy

Magnetic Resonance Imaging of the Globe-Tendon Interface for Extraocular Muscles: Is There an “Arc of Contact”?

“…The displaced LR force is no longer sufficient to balance the MR adducting force in central gaze, resulting in ET and horizontal diplopia in the distance that resolves on near gaze when the diminished LR force is no longer biomechanically important. The posteriorly sagging LR belly that defines “sagging eye syndrome 17, 18 “ can be directly treated with novel surgeries designed to correct the LR pulley displacement, such as loop myopexy 34 and LR equatorial myopexy 35 , without changing the position of the LR insertion. This approach can reduce tissue trauma, future risk of healing abnormalities such as stretched scar or hypertrophic scar, and patient morbidity.…”

Lateral rectus sag and recurrent esotropia in children

“…The surgical plan for 6.5 mm bilateral lateral rectus resections was modified to include equatorial myopexies to elevate the lateral rectus paths into vertical alignment with their insertions. 23 More than 8 months after his second surgery, the patient has remained orthophoric at both distance and near with normal versions and recovery of fusion on the Worth 4-dot test. Overelevation in adduction resolved.…”

“…Surgery was modified to resect each lateral rectus 4.5 mm with equatorial myopexy by permanent sutures placed 8 mm posterior to the superior margins of the muscle insertions through the equatorial sclera and adjacent superior third of the lateral rectus belly to elevate posterior lateral rectus paths into vertical alignment with their insertions ( Figure 2). 23 More than 3 years after reoperation, the patient has remained orthophoric at both distance and near, with normal versions.…”

“…Because of the severely abnormal lateral rectus position, the planned resection was abandoned and replaced by bilateral lateral rectus equatorial myopexy. 23 On the first postoperative day, the boy was orthophoric at distance, with an esotropia at near of 8 Δ . Six weeks after surgery, he was orthophoric at distance and near and exhibited normal ocular versions.…”

“…21,22 In such cases, correction of the lateral rectus path by equatorial myopexy can restore normal orthotropia. 23 Within our clinical practice, we recognized a small group of younger strabismic children who share two common characteristics. First, each patient experienced almost complete recurrence of preoperative esotropia after large bilateral medial rectus recessions.…”