# A Case of Strabismus Fixus With Extremely Long Axial Length Results in Improvement of Limitation of Abduction by the Yokoyama Procedure

## TL;DR

A 68-year-old woman with severe eye misalignment due to high myopia showed improved eye movement after a combined surgical procedure.

## Contribution

Demonstrates successful treatment of strabismus fixus with a long axial length using the Yokoyama procedure and medial rectus recession.

## Key findings

- The patient's abduction limitation improved after the Yokoyama procedure and medial rectus recession.
- MRI confirmed posterior eyeball dislocation in the right eye.
- Post-surgery, the patient achieved abduction beyond the midline with high satisfaction.

## Abstract

Acquired strabismus in high myopia is typically fixed in the positions of adduction and depression, with restrictions in both abduction and elevation. As a treatment for myopic strabismus fixus, the Yokoyama procedure is effective. We report a case of strabismus fixus with a long axial length (34 mm), in which abduction limitation was improved by the Yokoyama procedure with medial rectus recession. A 68-year-old woman was referred for strabismus fixus in her right eye. Her right eye was fixed in the positions of adduction and depression, with restrictions in both abduction and elevation. The axial length of her right eye was extremely long 33.97mm. Magnetic resonance imaging (MRI) showed that the posterior eyeball of her right eye had dislocated out of the superotemporal muscle cone, and she was diagnosed with strabismus fixus with high myopia. She underwent the Yokoyama procedure in her right eye, and medial rectus recession was performed at the same time because abduction limitations remained at the end of the Yokoyama procedure. After surgery, there was a small residual esotropia, but abduction beyond the midline was possible, and the patient's satisfaction was high. A combination of the Yokoyama procedure and medial rectus recession for a patient with myopic strabismus fixus with long axial length resulted in good improvement of ocular misalignment and limitation of abduction.