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^@D esotropia and the mean vertical deviation was 21.8^@D hypotropia. The mean postoperative horizontal deviation was 0^@D and vertical deviation was 4.4^@D hypotropia. Thus there were large improvements in both the vertical (17.4^@D) and the horizontal deviations (13^@D) 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.
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