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Myopic strabismus fixus is a rare
strabismus disorder
occurs in highly myopic patients
which progresses from a small degree of esotropia
with free ocular motility to the end stage
of
large angle esotropia
and hypotropia.
Imaging
these patients
have revealed abnormal extraocular muscle
position ; the lateral rectus is displaced
inferiorly and the superior rectus is
displaced
medially .
The most recent
explanation that the enlarged globe in high
myopia herniates through the muscle cone
between the SR and the LR muscle fixing the
globe in an esotropic and hypotropic
position .
What
is shocking in these patients that large
bilateral medial rectus recession and
bilateral lateral rectus resection usually
aggravate the deviation.
Resection of the
lateral rectus muscle must be avoided,
because it aggravates the globe herniation
out of the muscle cone.
There are different surgeries described
for the management of
Myopic Strabismus
Fixus
, including hemitransposition of rectus muscle, loop
myopexy and partial Jensen’s operation.
Recession of the medial rectus muscle is
only needed if the MR is found tight in the
time of surgery .
Yokoyama procedure
In our hospital,
after many years of disappointment in
managing these patients , I had adopted
Yokoyama procedure . Briefly, it is a
surgical procedure aiming to bind halves of
the superior and lateral rectus muscles and
fixing them at the sclera .
By using the muscle bellies to close the hernial
opening, the orbital movements were
significantly improved and a good cosmetic
as you see in this patient post operatively.
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