Lateral Rectus Equatorial Myopexy (LREM) for Sagging Eye Syndrome (SES)
Azam A. Qureshi; Federico G. Velez; Stacy L. Pineles; Sherwin J. Isenberg; Joseph L. Demer
UCLA Stein Eye Institute
Los Angeles, CA
Introduction: To report results of LREM for SES.
Methods: We reviewed records of three patients with age-related distance esotropia who underwent unilateral LREM by suturing the superior LR border to the equatorial sclera as a primary procedure (2 cases) or an adjunct. 1-month postoperative results were evaluated.
Results: All patients with SES exhibited at surgery the predicted significant inferior displacement of the LR pulley. Two cases also simultaneously underwent additional strabismus procedures. Mean age was 71 years (range 62-82). Median preoperative distance esotropia was 17PD (range 0-45) while the median ipsilateral hypodeviation was 5 PD (0-14). Surgery corrected to 2 PD median esotropia (0-6) and 1.6 PD (0-5) hyperdeviation at 1 month postoperatively. One patient has consecutive hypertropia who also had inferior rectus weakening.
Discussion: While standard surgeries such as medial rectus recessions can correct esotropia, these procedures are employed without correcting the underlying problem of the inferiorly displaced LR pulley and weakened LR-SR band. LREM for sagging eye syndrome is a viable surgical option for sagging eye syndrome presenting with hypotropia and/or esotropia. However, additional procedures should be incorporated cautiously as there is limited data regarding the results of equatorial myopexy for SES.
Conclusion: Given the mechanical nature of the sagging eye syndrome, LREM is a logical surgical approach that addresses the underlying pathophysiology.
References: 1. Chaudhuri Z., Demer J. L. Sagging eye syndrome: connective tissue involution as a cause of horizontal and vertical strabismus in older patients. JAMA Ophthalmology. 2013;131(5):619-625.
2. Clark T.Y., Clark R.A. Surgical correction of an inferiorly displaced lateral rectus with equatorial myopexy. J AAPOS. 2016 Oct;20(5):446.e1-446.e3.