Session: Poster session A

Strabismus surgery in high myopia: Is conventional horizontal surgery still a viable option?

Introduction: Strabismus in high myopia is often associated with a displacement of the extraocular muscles (EOM) by the elongated eye. Recent reports on strabismus surgery in high myopia suggest realignment of the EOM into their path by loop myopexy or transposition surgery, connecting horizontal and vertical EOM in order to avoid a posterior scleral fixation suture which carries an increased risk of scleral perforation in these long eyes with a thin sclera. The dose effect of these surgeries however appear less predictable than those previously reported for conventional horizontal strabismus surgery. Here we report the outcome of recess and/or resection or plication surgery for horizontal strabismus in myopia with or without posterior myopexy.

Methods: Retrospective chart review of patients that underwent surgery of strabismus associated with high myopia.

Results: 12 patients (5m, 7F) with a mean spherical equivalent of – 8.1 dpt (range up to -16.75) were analyzed. Six patients had been corrected for esotropia and 6 for exotropia. To summarize results, exotropic angles were converted to positive angles and thus the mean angle of deviation, measured with the alternate prism cover test was 30.6 prism diopters (PD) (SD: 16.9) at distance and 34 PD (SD:19.1) at near. Postoperatively no patient had a manifest angle 3 months post operatively. The mean dose effect at that time point was 2.9 PD/mm surgery at distance and 3.3 PD/mm surgery at near. A deviation of the muscle path was seen in 2 patients, which resulted in an additional posterior scleral fixation suture. In these 2 patients the DE was 3 PD/mm surgery at distance and at near. There were no complications such as scleral perforations.

Conclusion: In agreement with previous reports, our data confirm that conventional horizontal EOM surgery with or without posterior fixation remains a valuable option to treat strabismus in high myopia with a low risk and excellent predictability.