Effectiveness of surgical interventions for heavy eye syndrome: a systematic review and meta-analysis with...

The study aims to systematically review and analyze surgical treatments for Heavy Eye Syndrome (HES), focusing on outcomes and advantages of different procedures, to address the lack of consensus on its management and complications.

Following PRISMA guidelines (PROSPERO: CRD42024584537), PubMed, MEDLINE, Scopus, and CINAHL were searched up to October 2024 for studies addressing surgical management of HES. A total of 555 studies were identified, with 25 included in the systematic review, of which 19 were included in the meta-analysis. Statistical analysis, including subgroup meta-analyses and meta-regression, assessed mean differences (MDs) and standardized MDs (SMDs) in pre- and post-operative measures.

Across 19 studies that included a total of 539 eyes in the meta-analysis, significant improvements were observed. For esotropia, the pooled MD was -58.76 PD (95% CI: -70.01 to -47.50). Hypotropia improved with a pooled MD of -13.43 PD (95% CI: -16.57 to -10.28). Abduction limitation improvement showed an SMD of 2.47 (95% CI: 1.79 to 3.14). Elevation limitation improved by 1.62 (95% CI: 1.2 to 2.05). Techniques like Nishida and loop myopexy exhibited consistent results with notable improvements in globe displacement and alignment. Meta-regression identified factors like age and year of publication influencing outcomes.

Surgical interventions, particularly loop myopexy and muscle union techniques, significantly improve alignment and motility in HES. Despite variability in outcomes and substantial heterogeneity, findings highlight the need for standardized protocols and further multicenter trials.