Loop myopexy with true muscle transplantation for very large angle heavy eye syndrome patient

A 42-year-old man presenting with complaints of squint for last 20 years. His visual acuity was 20/400 in right eye (RE) and 20/30 in left eye (LE) with glasses. His refraction was RE -16.75/-2.5 D cycl 180 and LE was -14.5/-1.5 D cycl 180. His axial length was 31.23 mm In RE and 29.72 mm in LE. On examination we found he had RE large esotropia with hypotropia measuring 130 pd base out and 40 pd base up in RE. A computerized tomography scan revealed that the superior rectus (SR) was shifted nasally, and lateral rectus (LR) was shifted inferiorly. A RE medial rectus (MR) recession and LR resection with muscle transplantation on the MR was done. A loop myopexy was done to correct the path of the LR and SR. The patient had only 18 pd eso and 20 pd hypo on follow-up after 3 months. Loop myopexy in conjunction with muscle transplantation is a safe and effective procedure for large angle esotropia associated with heavy eye syndrome.