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com
Clinical science
1
Jasti V Ramanamma
Children’s Eye Care Centre,
LV Prasad Eye Institute,
Hyderabad, India
2
Nimagadda Prasad Children’s
Eye Care Centre, L V Prasad
Eye Institute, Visakapatnam,
India
Correspondence to
Dr Ramesh Kekunnaya, Head,
Jasti V Ramanamma Children’s
Eye Care Centre, Paediatric
Ophthalmology & Strabismus,
Kallam Anji Reddy Campus,
L.V. Prasad Eye Institute, L.
V. Prasad Marg, Banjara Hills,
Hyderabad 500034, India;
rameshak@lvpei.org,
drrk123@gmail.com
Previous presentation: Paper
presented at the AAPOS
Annual meeting, 2013,
Boston.
Received 27 February 2014
Revised 28 May 2014
Accepted 3 July 2014
Published Online First
4 August 2014
To cite: Shenoy BH,
Sachdeva V, Kekunnaya R.
Br J Ophthalmol
2015;99:36–40.
36
Silicone band loop myopexy in the treatment
of myopic strabismus fixus: surgical outcome
of a novel modification
Bhamy Hariprasad Shenoy,1 Virender Sachdeva,2 Ramesh Kekunnaya1
ABSTRACT
Aim To evaluate safety profile and surgical outcomes of
a novel modification of loop myopexy with silicone band
for myopic strabismus fixus (MSF).
Design Retrospective interventional case series.
Methods A retrospective chart review of patients who
underwent silicone band loop myopexy between January
2008 and December 2012 for MSF at a tertiary eye care
centre was undertaken. A minimum of 2 months of
follow-up after surgery was required for inclusion.
Patients who underwent conventional suture loop
myopexy and cases with incomplete details pertaining to
the preoperative alignment and movement restriction
were excluded. The main outcome measures were
improvement in alignment postoperatively, improvement
in extra-ocular motility postoperatively, and intraoperative
and postoperative complications.
Results 26 eyes of 15 patients (male (9):female (6)
=1.5:1) underwent silicone band loop myopexy at a
mean age of 27.8±16.4 years (range 7–72 years). Mean
follow-up was 7.9±8.4 months (range 2–28 months,
and median 4 months). 11 patients underwent bilateral
loop myopexy whereas four patients underwent
unilateral loop myopexy. 16 eyes underwent additional
medial rectus (MR) recession. At the last follow-up,
mean abduction limitation improved to −1.5±1.3 from
−2.9±1.2, p=0.0000; mean elevation limitation
improved to −1.2±0.9 from −2.8±1.1, p=0.0000;
mean esotropia improved to 16.9±17.4 prism dioptres
(PD) from 79.3±32.3PD, p=0.0000; and success
(deviation ≤20PD) was achieved in 73% (95% CI 48 to
89%). Mean hypotropia at presentation was
8.9±10.1PD (range 0–25PD), which improved to
0.6±1.3PD (range 0–4PD), p=0.007.
Conclusions Modified scleral fixated silicone band
loop myopexy with or without MR recession is a safe
and effective procedure in the management of MSF and
improves alignment significantly.
INTRODUCTION
Myopic strabismus fixus (MSF) is a rare condition
characterised by presence of esotropia and hypotro-
pia in high myopia with restricted abduction and
supraduction.1 2 In severe cases, the eye is fixed in
adduction and hypotropic position with no possible
movements in any other direction.3 4 Various theor-
ies have been put forth to explain the pathogenesis
of this condition in the past.1 5 Recent work by
Yokoyama and associates2 6 and Krzizok and
Schroeder7 have shown that there is an abnormality
in the muscle paths of superior rectus (SR) and
lateral rectus (LR) associated with supertemporal
dislocation of the posterior portion of the
Shenoy BH, et al. Br J Ophthalmol 2015;99:36–40. doi:10.1136/bjophthalmol-2014-305166
elongated globe out from the muscle cone which
leads to nasalisation of SR and downward displace-
ment of LR. The inferior displacement of LR leads
to weakening of its abducting force and converts it
into a depressor whereas nasalisation of SR
weakens its elevating force and converts it into an
adductor thereby leading to the eye being fixed it
esotropic and hypotropic position. Krzizok and
Schroeder7 and Aoki et al8 have demonstrated the
alteration in positions of SR and LR on MRI
studies. Management of MSF has been challenging
with the standard recess-resect procedure being
ineffective and recurrence of esotropia within few
months.1 6 9 10 With the recent understanding of
the pathophysiology of MSF, muscle belly union of
SR and LR using a non-absorbable suture or the
suture loop myopexy with or without scleral fix-
ation is currently the procedure of choice in man-
agement of this condition.6 11 More recently, there
have been concerns of muscle cheese wiring and
compromise of the anterior ciliary circulation with
the conventional suture loop myopexy.12 To
address these concerns, we have been using a novel
modification called the Silicone band Loop
myopexy in the treatment of MSF. The aim of this
study was to describe a novel modification of loop
myopexy with silicone band for MSF and to evalu-
ate its safety profile and surgical outcomes.
MATERIALS AND METHODS
A retrospective chart review of patients who under-
went silicone band loop myopexy between January
2008 and December 2012 for MSF at a tertiary eye
care centre was undertaken. The study was
approved by the institutional review board. We
included patients with a diagnosis of MSF based on
clinical examination and orbital imaging which was
confirmed by the senior author (RK). A minimum
of 2 months of follow-up after surgery was
required for inclusion. Patients who underwent
conventional suture loop myopexy were excluded.
We also excluded cases with incomplete details per-
taining to the preoperative alignment and move-
ment restriction and postoperative measurements at
2 months follow-up. Preoperatively all subjects
underwent a comprehensive ophthalmic examin-
ation including refraction and axial length (AL)
measurement with A-scan biometry wherever pos-
sible. The ocular movements were assessed by the
senior author (RK) in all patients and were divided
into 4 grades, with 1 = minimal limitation and 4 =
no movement towards and/or beyond the primary
position.2 9 12 Wherever possible, the deviation in
prism dioptres (PD) was measured by prism bar
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Clinical science

cover test; in patients with severe MSF with no movement pos-
sible in any direction, a corneal light reflex estimation technique
measured with prisms placed in front of both eyes was used to
estimate the deviation. All subjects underwent MRI with axial
and coronal T2-weighted spin-echo imaging with a slice thick-
ness of 3 mm. The images were analysed for any abnormality in
the orbit and shift in muscle position of SR and LR if any and
the findings were documented. The imaging and analysis were
performed according to the protocol published by Krzizok and
Schroeder.7
DATA COLLECTION
The parameters studied were patient demography, age at onset
of strabismus, duration of strabismus, refraction as spherical
equivalent (SE), AL, preoperative and postoperative limitation
of movements and horizontal and vertical deviation at
2 months, MRI findings, intraoperative and postoperative forced
duction test (FDT) findings, intraoperative findings of muscle
path, previous strabismus surgery with dosage if any and dosage
of MR recession when performed.
OPERATIVE TECHNIQUE
Under general anaesthesia, an intraoperative FDT was per-
formed to assess the tightness of each of the rectus muscles. A
fornix based conjunctival incision was placed in the supero-
temporal quadrant approximately 10–12 mm from the limbus.
The LR was hooked and isolated using muscle hooks and tenon
capsule reflected. The SR was hooked and isolated in a similar
manner from the same incision. The paths of both LR and SR
were examined intraoperatively and documented. Care was
taken to avoid superior oblique inclusion while operating on the
SR. A scleral tunnel of 3–4 mm length was then constructed 14–
16 mm from the limbus in between the bellies of SR and LR
using a hockey J stick buckle blade (Sharpedge, Gujarat, India)
(figure 5A). A type 240 silicone band (Figure 5B) (Mira,
Uxbridge, Massachusetts, USA) was then passed under the LR
and through the scleral tunnel and under SR (figure 5C). The
two ends were then passed through a Watzke sleeve (Mira)
(Figure 5D) and tightened to bring the bellies of SR and LR
together by pulling the two ends in opposite direction
(figure 5E). The ends of the silicone band were cut close to the
edge of the sleeve (figure 5F). The sleeve with the bands was
further secured by placing a suture through them with 5–0 non-
absorbable green braided polyester suture (Alcon, Texas, USA).
This extra suture placement was done in the earlier cases, but
later on it was discontinued. The conjunctiva was closed with
interrupted sutures using an 8–0 non-absorbable monofilament
nylon suture (Aurolab, Tamil Nadu, India). An FDT was
repeated to look for the tightness and a medial rectus (MR)
recession was performed if the MR tightness was thought to be
significant.
MAIN OUTCOME MEASURES
The main outcome measures were improvement in alignment
postoperatively, improvement in extra-ocular motility postopera-
tively and intraoperative and postoperative complications
including globe perforation, lost muscle, splitting of muscle, sili-
cone band related complications and anterior segment ischae-
mia. A success was defined as postoperative deviation ≤20PD at
the last follow-up.
STATISTICAL ANALYSIS
In patients, a paired t test was used to evaluate changes in
maximum angles of abduction and elevation, and ocular devi-
ation. Statistical analyses were performed using commercial soft-
ware (Stata V.11; StataCorp, College Station, Texas, USA).
A p value<0.05 was considered statistically significant.
RESULTS
A total of 26 eyes of 15 patients (male (9):female (6)=1.5:1)
underwent silicone band loop myopexy during the study period.
The mean age at surgery was 27.87±16.4 years (range
7–72 years). The mean age at onset of strabismus was
17.8±17.48 years. Mean follow-up duration was 7.93±8.48
months (range 2–28 months, and median 4 months). Eleven
patients underwent bilateral loop myopexy whereas four patients

Table 1 Distribution of the demographic and clinical features of all the patients in the series
BCVA Axial Length
(logMar) (mm) Preoperative deviation Deviation at last follow-up
Patient OD OS OD OS Esotropia (PD) Hypotropia (PD) Surgery performed Esotropia (PD) Hypotropia (PD)

1 1.8 3 35.57 35.26 95 NA OU LM+OS MRc (5 mm) 0 NA

2 1 0 26.8 22.19 30 16PD RHOT OS LM 8 4PD RHoT
3 1.8 1.3 34.3 34.4 110 NA OU LM 10 NA
4 3 1.3 NA NA 30 20PD RHOT OD LM+MRc 7 mm LRr 5.5 mm 0 0
5 1.8 1.3 35.14 32.76 120 NA OU LM+OD MRc 7 mm 40 NA
6 2 2 33.07 32.72 80 NA OU LM+OU MRc (6 mm) 25 0
7 1.3 1 35.68 34.55 60 0 OU LM+OU MRc (6 mm) 14 0
8 1.8 1.8 36.41 36.46 130 NA OU LM+OU MRc (7 mm) 50 NA
9 1.3 0.7 29 28 95 NA OU LM+OD MRc (5 mm) 50 NA
10 2 2 30.36 30.25 60 8PD RHOT OU LM+OU MRc (5 mm) 0 RHT 2PD
11 1.3 1.8 33.48 32.01 120 NA OU LM+OU MRc (7.5 mm) 20 NA
12 0.3 0.2 27.32 27.81 70 0 OU LM 0 0
13 3 3 31.01 31.18 80 0 OU LM+OU MRc recession (7 mm) (two-stages) 20 0
14 0.2 3 22.86 27.94 40 25PD LHOT OS LM 6 Nil
15 3 0 31.65 24.69 70 12PD RHOT OD LM 10 0
BCVA, best corrected visual acuity; LHOT, left hypotropia; LM, loop myopexy; LRr, lateral rectus resection; MRc, medial rectus recession; NA, not available (for some of the patients these
measurements were either not recorded/difficult to make with large angle of esotropia); OD, oculus dexter (the right eye); OS, oculus sinister (the left eye); OU, oculus uterque (both
eyes); PD, prism dioptres; RHOT, right hypotropia.

Shenoy BH, et al. Br J Ophthalmol 2015;99:36–40. doi:10.1136/bjophthalmol-2014-305166 37

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Clinical science
Figure 1 Modified silicone band loop myopexy: Box and whisker plot
showing the distribution of abduction limitation in patients at
presentation and last follow-up.
underwent unilateral loop myopexy (table 1). Additional MR
recession was performed in 10 patients (16 eyes) (four unilateral
and six bilateral) (table 1). The range of MR recession performed
was 5–7.5 mm. In one patient, a bilateral loop myopexy was per-
formed 1 month following the bilateral MR recession recession.
One eye had undergone an LR resection of 5.5 mm and MR
recession of 7 mm in addition to a unilateral loop myopexy.
Four patients had horizontal binocular diplopia at presenta-
tion. At the last follow-up, only one patient had minimal persist-
ing diplopia. In all, 24 eyes had nasalisation of SR and inferior
displacement of LR on MRI orbit. The remaining two eyes were
not found to have the an anomalous path of LR and SR on the
MRI but found to have an anomalous downshift of the insertion
of MR and LR intraoperatively in addition to the altered paths
of LR and SR, which were not seen on MRI orbit. The mean SE
refraction was −16.3±6.3 dioptres (range −6 to −27, n=14)
and mean best corrected visual acuity was 1.6±0.93 (range 0.3
to 3) logMar at presentation. Mean AL was 31.98±3.02 mm
(range 26.8–36.46, n=24).
Mean abduction limitation at presentation was −2.9±1.2 (−6
to −1) which improved to −1.5±1.3 (−5 to 0), p=0.0000 at
the last follow-up (figure 1). Mean elevation limitation at pres-
entation was −2.8±1.1 (−6 to −1) which improved to −1.2
±0.9 (−3 to 0), p=0.0000 at the last follow-up (figure 2).
Figure 2 Modified silicone band loop myopexy: Box and whisker plot
showing the distribution of limitation of elevation in patients at
presentation and last follow-up.
38 Shenoy BH, et al. Br J Ophthalmol 2015;99:36–40. doi:10.1136/bjophthalmol-2014-305166
Figure 3 Modified silicone band loop myopexy: Box and whisker plot
showing the distribution of mean esotropia at presentation and last
follow-up.
Mean esotropia at presentation was 79.3±32.3PD (range 30–
130), which improved to 16.9±17.4PD (range 0–50),
p=0.0000 (figure 3) and success (deviation within 20PD) was
achieved in 73% (95% CI 48 to 89%) at the last follow-up.
Mean hypotropia at presentation was 8.9±10.1PD (range 0–
25PD), which improved to 0.64±1.33PD (range 0–4PD),
p=0.0069. Two patients had foreign body sensation due to sili-
cone band which necessitated removal of two eyes. There was
no incidence of anterior segment ischaemia or other adverse
events due to silicone band in any of the patients.
DISCUSSION
The management of MSF has undergone a paradigm shift in the
past decade.1 6 9 12 This advancement has been possible largely
due to better understanding of the pathogenesis of this condi-
tion.1 2 7 Herzau and Loannakis13 for the first time observed
intraoperatively an abnormal path of the LR in MSF. However,
it was Krzizok and Schroeder7 who for the first time identified a
shift in LR which was also seen on MRI as a pathogenesis of
this condition. This study put to rest various older theories like
myositis theory by Hugonnier and Magnard,14 LR paralysis
theory of Paufique and others, theory of myopathic paralysis of
the LR by pressure from the lateral orbital wall by Bagolini
et al3 and so on. Herzau and Loannakis13 and Krzizok and
Schroeder7 recommended upshifting of the LR in order to
correct its path and thereby normalising the vector forces as the
treatment of MSF based on their findings. However, both the
author groups could not explain the limitation of elevation seen
in patients with MSF. Yokoyama et al2 reported abnormalities in
the path of both LR and SR secondary to supertemporal disloca-
tion of the posterior portion of the elongated globe out from
the muscle cone as seen in MSF and thereby successfully
explained the cause for eye being fixed in esotropic and hypo-
tropic position in MSF. The shifts in position of LR and SR
have been further studied by various authors using MRI and
have reiterated the findings of Yokoyama et al.1 2 7 8 Based on
their observation, Yokoyama et al2 15 recommended muscle
belly union of SR and LR by means of loop myopexy as the
treatment for MSF. Currently, suture loop myopexy with or
without scleral fixation and with or without MR recession is the
procedure of choice for MSF and its effectiveness is well
established.6 11 12 15
The potential disadvantages of suture loop myopexy are
muscle cheese wiring, strangulation of anterior ciliary circulation
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Clinical science

Figure 4 Patient 12 with myopic strabismus fixus. (Left) Preoperative 9-gaze photograph showing 70 prism dioptres esotropia with restriction of
abduction and elevation. (Right) 9-Gaze photograph of the patient at last follow-up showing improved extra-ocular movements with orthotropia.

and the procedure being potentially non-reversible.12 16
Different materials have been used to perform a loop myopexy
in order to overcome the disadvantages of the suture loop
myopexy.12 16 We have been using a modified loop myopexy
with the help of a type 240 silicone band with scleral fixation
by constructing a scleral tunnel in treatment of MSF. Wong
et al12 reported favourable outcomes in an isolated case treated
with silicone band loop myopexy without scleral fixation
14 months postoperatively. The authors believe that silicone
band loop myopexy without scleral fixation has an increased
risk of migration of the band especially in eyes with large AL.
Hence we modified the procedure with scleral fixation.
The mean AL in the present cohort was 31.98±3.02 mm,
which was comparable with previous studies on MSF.6 9 11 12 16
The mean age of the patient in the present study was 27.87
±16.4 years which was lower than that reported in previous
studies.6 11 12 The present study found that silicone band loop
myopexy significantly improved ocular alignment and
extra-ocular motility (figures 1–3). This was consistent with the
previous reports on effectiveness of suture loop myopexy6 9 11 12
thereby implying that silicone band loop myopexy was as effect-
ive as suture loop myopexy. We defined success as a deviation
≤20PD. This was achieved in 73% patients (95% CI 48 to 89%).
In all, 53.3% of the patients had a final deviation of ≤10PD.
Figure 4 shows a collage of preoperative and postoperative
photographs of patient 12 who had 70PD esotropia preopera-
tively and underwent bilateral silicone band loop myopexy. The
patient was orthotropic at the last follow-up.
Five patients underwent silicone band loop myopexy without
MR recession. Even in patients who underwent bilateral loop
myopexy, a unilateral MR recession was performed in three
eyes. The decision to perform an additional MR recession was
taken based on the intraoperative FDT before and after per-
forming a silicone band loop myopexy and based on the sur-
geon’s (RK) assessment of the tightness of MR. The total
cumulative esotropia in five patients (seven eyes) who under-
went isolated loop myopexy without MR recession was 330PD.
At the last follow-up, the cumulative esotropia in these patients
postoperatively was 40PD. Hence, it can be inferred that sili-
cone band loop myopexy alone effectively corrects approxi-
mately 40PD of esotropia (330/7=47).
The potential complications with our technique are intrao-
perative scleral perforation and postoperative foreign body sen-
sation due to the presence of the band-sleeve complex. We did

Figure 5 (A–F) Intraoperative photographs showing modified silicone band loop myopexy. (A) Making a scleral tunnel using a hockey J stick knife
about 12 mm posterior to the limbus in the superotemporal quadrant between superior rectus and lateral rectus muscles. (B) Passing the type 240
scleral band below the superior rectus and the scleral tunnel. (C) Passing the type 240 scleral band around the lateral rectus muscle. (D) Passing the
two ends of type 240 scleral band through the Watzke sleeve. (E) Tightening the scleral band through the scleral buckle. (F) Final appearance after
tightening the scleral band showing the close apposition of the superior and lateral rectus muscles using the band.
Shenoy BH, et al. Br J Ophthalmol 2015;99:36–40. doi:10.1136/bjophthalmol-2014-305166 39
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Clinical science
not have a scleral perforation in any of the eyes. Foreign body
sensation was reported by two patients (three eyes) and a sili-
cone band removal was performed in two eyes of one patient
5 months postoperatively. The patient is maintaining alignment
24 months postoperatively. The other patient was lost to
follow-up. Binocular diplopia was seen in four patients at pres-
entation. At the last follow-up, one of these patients had
minimal binocular vertical diplopia persisting due to 3PD right
hypertropia and was managed with prisms.
The current study has the advantage of being the largest
series of the patients undergoing loop myopexy for the manage-
ment of MSF. Our study does have certain drawbacks due to its
retrospective nature. In addition, we included one patient who
underwent a loop myopexy after 1 month of undergoing bi-MR
recession elsewhere. One patient underwent unilateral loop
myopexy with additional LR resection of 5.5 mm and 7 mm
MR recession for unilateral MSF with 70PD esotropia as we
expected residual esotropia with unilateral loop myopexy and
MR recession alone. However, the patient was orthotropic at
the last follow-up and had no recurrence. The authors agree
that this could have slightly skewed the results.
In conclusion, our study does suggest that modified scleral
fixated silicone band loop myopexy with or without MR recession
is a safe and effective procedure in the management of MSF and
improves alignment significantly. Loop myopexy alone can correct
up to 40PD of esotropia and this should be kept in mind while
planning a surgery. Further studies particularly those comparing
suture and silicone band loop myopexy looking at the anterior
ciliary circulation and muscle related complications are needed.
Acknowledgements The authors thank Mr Naresh Gattu and Mr Praveenkumar
for technical assistance. We also thank our patients.
Contributors Design of the study: BHS, RK; conduct of the study: BHS, RK, VS;
management: RK; analysis and interpretation of the data: BHS, RK, VS; preparation,
review or approval of the manuscript: BHS, RK, VS.
Funding Hyderabad Eye Research Foundation, Hyderabad, India.
Competing interests None.
Ethics approval IRB of L V Prasad Eye Institute.
Provenance and peer review Not commissioned; externally peer reviewed.
40
Patient consent Obtained.
Data Sharing Data available on request. Requests to be directed to the
corresponding author.
REFERENCES
1 Krzizok TH, Kaufmann H, Traupe H. New approach in strabismus surgery in high
myopia. Br J Ophthalmol 1997;81:625–30.
2 Yokoyama T, Tabuchi H, Ataka S, et al. The mechanism of development in
progressive esotropia with high myopia. In: de Faber J-T, ed. Transactions: 26th
Meeting, European Strabismological Association, Barcelona, Spain, 2000. Lisse
(Netherlands): Swets & Zeitlinger, 2001:218–22.
3 Bagolini B, Tamburrelli C, Dickmann A, et al. Convergent strabismus fixus in high
myopic patients. Doc Ophthalmol 1990;74:309–20.
4 Kowal L, Troski M, Giford E. MRI in the heavy eye phenomenon. Aust N Z J
Ophthalmol 1994;22:125–6.
5 Duke-Elder S, Wybar KC. Strabismus fixus. In: Duke-Elder S, ed. System of
Ophthalmology. Volume 6. London: Henry Kimpton, 1973:607–8.
6 Yamaguchi M, Yokoyama T, Shiraki K. Surgical procedure for correcting globe
dislocation in highly myopic strabismus. Am J Ophthalmol 2010;149:341–6.
7 Krzizok TH, Schroeder BU. Measurement of recti eye muscle paths by magnetic
resonance imaging in highly myopic and normal subjects. Invest Ophthalmol Vis Sci
1999;40:2554–60.
8 Aoki Y, Nishida Y, Hayashi O, et al. Magnetic resonance imaging measurements of
extraocular muscle path shift and posterior eyeball prolapse from the muscle cone in
acquired esotropia with high myopia. Am J Ophthalmol 2003;136:482–9.
9 Sturm V, Menke MN, Chaloupka K, et al. Surgical treatment of myopic
strabismus fixus: a graded approach. Graefes Arch Clin Exp Ophthalmol
2008;246:1323–9.
10 Hayashi T, Iwashige H, Maruo T. Clinical features and surgery for acquired
progressive esotropia associated with severe myopia. Acta Ophthalmol Scand
1999;77:66–71.
11 Leo SW, Del Monte MA. Surgical correction of myopic strabismus fixus by modified
loop transposition with scleral myopexy. J AAPOS 2007;11:95.
12 Wong I, Leo SW, Khoo BK. Loop myopexy for treatment of myopic strabismus fixus.
J AAPOS 2005;9:589–91.
13 Herzau V, Loannakis K. Zur Pathogenese der Konvergenz und Hypotropie bei hoher
Myopie. Klin Monatsbl Augenheilkd 1996;208:33–6.
14 Hugonnier R, Magnard P. Les déséquilibres oculomoteurs observé en cas de myopie
forte. Ann Oculist (Paris) 1969;202:713–24.
15 Yokoyama T, Ataka S, Tabuchi H, et al. Treatment of progressive esotropia caused
by high myopia—a new surgical procedure based on its pathogenesis. In: de
Faber J-T, ed. Transactions: 27th Meeting, European Strabismological
Association, Florence, Italy, 2001. Lisse (Netherlands): Swets & Zeitlinger,
2002:145–8.
16 Shih MH, Li ML, Huang FC. A preequatorial Gore-Tex sling to restore rectus muscle
pathways in myopic strabismus fixus. J AAPOS 2012;16:80–2.
Shenoy BH, et al. Br J Ophthalmol 2015;99:36–40. doi:10.1136/bjophthalmol-2014-305166
 Downloaded from http://bjo.bmj.com/ on March 6, 2016 - Published by group.bmj.com

Silicone band loop myopexy in the treatment

of myopic strabismus fixus: surgical
outcome of a novel modification
Bhamy Hariprasad Shenoy, Virender Sachdeva and Ramesh Kekunnaya

Br J Ophthalmol 2015 99: 36-40 originally published online August 4,

2014
doi: 10.1136/bjophthalmol-2014-305166

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