Pediatric myopic strabismus fixus: clinical features and surgical outcomes of silicone band loop myopexy

Strabismus. 2024 Mar;32(1):30-38. doi: 10.1080/09273972.2024.2306348. Epub 2024 Feb 21.


Purpose: To evaluate the clinical profile of myopic strabismus fixus (MSF) in children and surgical outcomes of silicone band loop myopexy.

Method: We retrospectively reviewed records of children presenting with MSF who underwent silicone band loop myopexy between January 2008 and December 2020 at a tertiary eye care center. Data concerning demographics, refractive error, axial length, extra-ocular motility, and ocular alignment pre-operatively and post-operatively, intra- and post-operative complications, ocular and systemic associations, were evaluated. The long-term effects of band loop myopexy on ocular alignment stability, motility improvement, and myopia progression were analyzed. Surgical outcome was defined as post-operative orthotropia or heterotropia less than or equal to 20 PD.

Results: A total of0 eyes of 7 patients (median age: 5 years; 5 boys and 2 girls) who underwent band loop myopexy were included in the study. Among them, three children underwent bilateral and four children underwent unilateral band loop myopexy. Medial rectus recession was performed only in two patients as a part of initial procedure. The median follow-up duration was 7 years. Most of the children, i.e. six of them presented with esotropia-hypotropia and only one patient presented with exotropia-hypotropia complex. The median pre-operative measurements were esotropia of 62.5 PD, hypotropia of5 PD, and exotropia of4 PD. Postoperative average primary position deviation measured was close to 9-10 PD of esotropia. The overall motility improved to -1 from -3.

Conclusion: The clinical profile of MSF in children is almost similar to adults. This condition is a rare entity among adults as well as children. Majority of children with MSF presented with esotropia-hypotropia complex. Silicone band loop myopexy with or without medial rectus recession proves to be a reliable surgical procedure as it provides stable outcomes in terms of ocular alignment and motility among children.

Keywords: High myopia; Myopic strabismus fixus; esotropia; loop myopexy; strabismus.

MeSH terms

  • Child
  • Child, Preschool
  • Eye Movements / physiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Myopia* / complications
  • Myopia* / physiopathology
  • Myopia* / surgery
  • Oculomotor Muscles* / physiopathology
  • Oculomotor Muscles* / surgery
  • Ophthalmologic Surgical Procedures* / methods
  • Refraction, Ocular / physiology
  • Retrospective Studies
  • Silicone Elastomers
  • Strabismus / etiology
  • Strabismus / physiopathology
  • Strabismus / surgery
  • Treatment Outcome
  • Vision, Binocular / physiology
  • Visual Acuity / physiology


  • Silicone Elastomers