Reoperation of Highly Myopic Strabismus by Surgical Procedure Joining the Lateral Rectus and Superior Rectus Muscles

doi:10.3877/cma.j.issn.2095-2007.2018.05.003

Abstract

Abstract:

Objective

To evaluate the effect of surgical procedure joining the lateral rectus and superior rectus muscles in the reoperation of highly myopic strabismus who failed to conventional surgery.

Methods

From September 2012 to December 2017, 5 patients (8 eyes), 2 males (4 eyes) and 3 females (4 eyes), aged 52.0-73.0 years, with an average of (61.2±2.4) with high myopia restricted esotropia who had undergone strabismus correction again at Xiamen Ophthalmological Center affiliated to Xiamen University due to ineffective conventional retraction surgery were collected. Year old. Before and after surgery, all patients underwent visual acuity, refraction, slit lamp microscopy, fundus, eye movement, oblique angle, axial length, coronal and horizontal computed tomography (CT) examination. Partial ligation of lateral rectus and superior rectus was performed.

Results

5 cases (8 eyes) were in the inferior oblique position with limited external and upward rotation. CT showed that the superior rectus muscle shifted to the nasal side, the lateral rectus muscle moved downward, and the posterior part of the eyeball herniated to the superior temporal muscle cone. 2 cases (4 eyes) underwent partial ligation of lateral rectus and superior rectus, 1 case (2 eyes) underwent partial ligation of lateral rectus and superior rectus combined with recession suspension of medial rectus, and 2 cases (2 eyes) underwent partial ligation of lateral rectus and superior rectus. At the follow-up of more than 6 months, 4 cases (6 eyes) were in the first eye position after operation, and 1 case (2 eyes) had the first eye position of -15°in the long term. CT showed that the dislocated eye was returned to the conus muscularis, and the function of the external and upward rotation of the eye gradually recovered. No diplopia occurred in all patients. No complications occurred.

Conclusions

Surgical procedure joining the lateral rectus and superior rectus muscles can effectively correct highly myopic strabismus which is ineffective after conventional surgery. It can also restore the dislocated globe back into the muscle cone and improve the function of eye movement.

Key words: Strabismus, Myopia, Surgical procedure

Jianfu Zhuang, Haiyan Wang, Shuhui Xu, Meihua Pan. Reoperation of Highly Myopic Strabismus by Surgical Procedure Joining the Lateral Rectus and Superior Rectus Muscles[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2018, 08(05): 209-215.

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References 25

[1]	Demer JL, Von Noorden GK. High myopia as unusual cause of restrictive motility disturbance[J]. Surv Ophthalmol, 1989, 33(4): 281-284.
[2]	Hayashi T, Iwashige H, Maruo T. Clinical features and surgery for acquired progressive esotropia associated with severe myopia[J]. Acta Ophthalmol Scad, 1999, 77(1): 66-71.
[3]	Ahadzadeghan I, Akbari MR, Ameri A, et al. Muscle belly union for treatment of myopic strabismus fixus[J]. Strabismus, 2009，17(2): 57-62.
[4]	杨培增, 范先群. 眼科学[M]. 9版. 北京：人民卫生出版社，2018：242.
[5]	亢晓丽, 韦严, 赵堪兴，等. 改良的Yokoyama术治疗高度近视眼限制性内下斜视[J]. 中华眼科杂志，2011，47 (11)：972-977.
[6]	Mansour AM, Wang F, el－Baba F, et al. Ocular complications in strabismus fixus convergens[J]. Ophthalmologica, 1987, 195(3): 161-166.
[7]	Kaynak S, Durak I, Ozaksoy D, et al. Restrictive myopic myopathy: computed tomography, magnetic resonance imaging, echography, and histological findings[J]. Br J Ophthalmol, 1994, 78(5): 414-415.
[8]	Bagolini B, Tamburrelli C, Dickmann A, et al. Convergent strabismus fixus in high myopic patients[J]. Doc Ophthalmol, 1990, 74(4): 309-320.
[9]	Kowal L, Troski M, Gilford E. MRI in the heavy eye phenomenon[J]. Aust N Z J Ophthalmol, 1994, 22(2): 125-126.
[10]	Taylor R, Whale K, Raines M. The heavy eye phenomenon：orthoptic and ophthalmic characteristics[J]. Ger J Ophthalmol, 1995, 4(4): 252-255.
[11]	Sturm V, Menke MN, Chaloupka K, et al. Surgical treatment of myopic strabismus fixus：a graded approach[J]. Graefes Arch Clin Exo Ophthalmol, 2008, 246(9): 1323-1329.
[12]	Hayashi T, Iwashige H, Maruo T. Clinical features and surgery for acquired progressive esotropia associated with severe myopia[J]. Acta Ophthalmol Scand, 1999, 77(1): 66-71.
[13]	Krzizok TH, Kaufmann H, Traupe H. Elucidation of restrictive motility in high myopia by magnetic resonance imaging[J]. Arch Ophthalmol, 1997, 115(8): 1019-1027.
[14]	Krzizok TH, Kaufmann H, Traupe H. New approach in strabismus surgery in high myopia[J]. The British Journal of Ophthalmology, 1997, 81( 8): 625-630.
[15]	Yamaguchi M, Yokoyama T, Shiraki K. Surgical procedure for correcting globe disclocation in highly myopic strabismus[J]. Am J Ophthalmol, 2010, 149(2): 341-346.
[16]	韦严, 亢晓丽. Yokoyama手术治疗高度近视眼限制性下斜视的研究进展[J]. 中华眼科杂志，2014, 50(7)：547-549.
[17]	Aoki Y, Nishida Y, Hayashi O, et al. Magnetic resonance imaging measurements of extraocular muscle path shift and posterior eyeball prolapse from the muscle cone in acquired esotropia with high myopia[J]. Am J Ophthalmol, 2003, 136(3): 482-489.
[18]	韩晓梅, 赵堪兴．人眼直肌Pulley与直肌肌肉纤维毗邻关系的研究[J]. 眼科新进展，2007，27(11): 805-807.
[19]	Akizawa Y, Yasuzumi K, Tanaka A. Morphological findings in progressive esotropia with high myopia[J]. Nippon Ganka Gakkai Zasshi, 2002, 106(7): 411-415.
[20]	Ohba M, Kawata H, Ohguro H. An unusual case of adult progressive esotropia caused by high myopia[J]. Binocular Vis Strabismus Q, 2008, 23(1): 31-35.
[21]	牛兰俊, 林肯, 韩惠芳. 实用斜视弱视学[M]. 苏州：苏州大学出版社，2016：412.
[22]	葛坚, 王宁利. 眼科学[M]. 3版. 北京：人民卫生出版社，2015：443.
[23]	Yamada M, Taniguchi S, Muroi T, et al. Rectus eye muscle paths after surgical correction of convergent strabismus fixus[J]. Am J Ophthalmol, 2002, 134(4): 630-632.
[24]	马鸿娟, 张芳霞, 马润清. 改良Yokoyama术治疗高度近视眼限制性内下斜视的临床观察[J]. 宁夏医学杂志，2015 ，37 (7)：608-610.
[25]	Basmak H, Sahin A, Yildirim N. Surgical treatment of strabismus fixus associated with high myopia[J]. Ophthalmic Surg Lasers Imaging, 2008, 39(5): 397-398.

序号	性别	年龄	眼别	矫正视力	眼轴(mm)	术前斜视角(PD)	外转受限程度分级	上转受限程度分级
1	女	52	右	0.1	32.23	＋60，R/L15	－4	－4
1	女	52	左	指数	32.08	＋70	－4	－4
2	男	73	右	0.3	31.41	＋50，R/L20	－4	－4
2	男	73	左	指数	30.85	＋65	－4	－4
3	女	57	右	0.05	29.89	＋110，L/R25	－3	－3
4	男	61	右	手动	32.57	＋130，L/R40	－4	－4
5	女	63	右	0.2	29.54	＋30，R/L30	－2	－2
5	女	63	左	指数	29.67	＋110	－3	－3

序号	性别	年龄	眼别	矫正视力	眼轴(mm)	术前斜视角(PD)	外转受限程度分级	上转受限程度分级
1	女	52	右	0.1	32.23	＋60，R/L15	－4	－4
1	女	52	左	指数	32.08	＋70	－4	－4
2	男	73	右	0.3	31.41	＋50，R/L20	－4	－4
2	男	73	左	指数	30.85	＋65	－4	－4
3	女	57	右	0.05	29.89	＋110，L/R25	－3	－3
4	男	61	右	手动	32.57	＋130，L/R40	－4	－4
5	女	63	右	0.2	29.54	＋30，R/L30	－2	－2
5	女	63	左	指数	29.67	＋110	－3	－3

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