J Korean Ophthalmol Soc.  2013 Mar;54(3):534-539. 10.3341/jkos.2013.54.3.534.

A Case of Yokoyama Procedure in Myopic Strabismus Fixus

• Pak KY
• Jung JH
• Choi HY

• KMID: 2216779
• DOI: http://doi.org/10.3341/jkos.2013.54.3.534

Abstract

PURPOSE
To present a surgical result of Yokoyama procedure in myopic strabismus fixus.
CASE SUMMARY
A 51-year-old female patient presented with progressive esotropia and diplopia. According to the Krimsky test, the patient showed 70 prism diopter esotropia and 30 prism diopter hypotropia in her left eye. The axial length was 34.97 mm in the right eye and 33.71 mm in the left eye. The patient was diagnosed with myopic strabismus fixus. The authors performed the Yokoyama procedure on her left eye. Surgical examination revealed each medial rectus muscle was recessed. Half of the muscle bellies of the superior and lateral rectus muscles were sutured together without muscle splitting 15 mm posterior from their insertion. At 1 year postoperatively, the patient showed 30 prism diopter esotropia and 20 prism diopter hypotropia in her right eye by alternative prism cover test. The authors performed the same procedure on her right eye. At 2 months after the second surgery, the patient showed orthotropia in the primary position and gaze limitation was improved.
CONCLUSIONS
The Yokoyama procedure can be an effective method for improving deviation and ocular motility in esotropia caused by high myopia.

Keyword

High myopia; Myopic strabismus fixus; Yokoyama

MeSH Terms

Diplopia
Esotropia
Eye
Female
Humans
Muscles
Myopia
Strabismus

Figure

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  Figure 1. (A) Preoperative photograph shows limitation of abduction and supraduction of the left eye. In primary position, She showed 70 prism diopter LET and 30 prism diopter LHoT. (B) Postoperative 1 year photograph shows improved movement of left eye. Her preferred eye changed from right to left eye. She showed 30-prism diopter RET and 20 prism diopter RHoT. LET = left esotropia; LHoT = left hypotropia.

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  Figure 2. (A) Preoperative computed tomography shows elongated globe and disproportion between globe and orbit. Downward displacement of lateral rectus muscle is noted. (B) Postoperative computed tomography shows restoration of dislocated globe and improvement of downward displacement of lateral rectus muscle on left eye. A = angle of dislocation; S = superior rectus muscle; L = lateral rectus muscle.

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  Figure 3. Intraoperative findings. Bind the muscle bellies of superior rectus (SR) and lateral rectus (LR) without splitting each muscle.

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  Figure 4. Postoperative two-months after Yokoyama procedure on both of the eyes. Photograph demonstrates orthotropia in primary position. Gaze limitation is fully recovered except -1 degree upward gaze limitation in both eyes.

Reference

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