VT246 : Modified loop myopexy without muscle split

Dr.Pratibha Panmand, Dr.Jyoti Matalia

To describe an alternative method of loop myopexy using non absorbable suture without muscle split in a rare case of 5 year old boy with myopic strabismus fixus with chromosome 9 inversion and duplication. This child underwent a medial rectus recession with modified loop myopexy procedure with 5-0 Dacron suture passed through the lateral rectus and superior rectus without muscle splitting but with splaying of these muscles in the supero-temporal quadrant. This procedure was preferred since the muscles were very widely displaced. Post surgical exotropia in our case thus confirmed the fact that ,on table forced duction test can lead to false positive results and hence medial rectus recession surgery should be planned after looping the displaced muscles proves insufficient in correcting the abnormal muscle paths. The splaying of the lateral and superior rectus in the supero-temporal quadrant can help prevents the globe subluxation and future recurrence.