[Inferior Rectus Myopexy: Indications and Long-Term Results].

PURPOSE: The rectus inferior myopexy is often used in vertical incomitant deviations without significant deviation in primary position. We analysed the long-term results in different pathologies.

METHODS

Retrospective study of patients operated on rectus inferior myopexy between 1984 and 2018. Vertical and torsional deviations were measured in primary position (PP) and 25° downgaze and the field of binocular single vision (FBSV) was evaluated with the Harms tangent screen, establishing a functional score. Postoperative follow-ups took place at 1 month, 6 months and long term (1 - 24 years).

RESULTS

62 patients were included (mean age 41 years, 28 women and 34 men). 47 presented a fourth nerve palsy (group 1) and 15 a reduced depression of other origins (group 2). 31 patients had undergone previous operations and 34 contemporaneous operations with the myopexy. In group 1, preoperative mean vertical deviation was 6.4° in PP and 12.3° on downgaze, postoperative 4° and 7.2°. In group 2, the value decreased from 3.3° in PP and 11.5° on downgaze to 1.2° and 6.6°. Over the years, there has been a decrease in the effect, particularly in group 1. The torsion was hardly influenced in both groups. The median functional score of FBSV improved in group 1 from 10% preoperatively to 39% postoperatively and in group 2 from 25 to 69%.

CONCLUSION

The inferior rectus myopexy shows an effective way to reduce the incomitance of vertical deviation without significant influence on torsion. Over the years, there has been a decrease in the effect, particularly in patients with superior oblique paresis. We do not consider inferior rectus myopexy as a classic surgical treatment of superior oblique paresis. We have only used it in special cases.