Introduction: Surgical treatment of esotropia (ET) associated with high myopia has been a challenge for many years, since conventional recession or resection procedures of the horizontal rectus muscles often have disappointing results. We describe two cases of children with ET associated with high myopia treated with a superior plication of the lateral rectus muscle (LRM) described by Yair Morad (World Society of Paediatric Ophthalmology and Strabismus subspeciality day 2023).
Methods: In this technique, using a 6-0 vicryl™ suture, the superior half of the LRM is secured 4 mm posterior to its insertion. The same suture is then passed through the sclera, 2 mm anterior and 2 mm superior to the insertion of the LRM. Patients were selected if high myopia was confirmed (cycloplegic refraction sphere < -6.00 diopters and axial length > 25 mm) and presented an ET > 14 prism diopter (PD) with no vertical deviation.
Results: The first case refers to a 11-year-old girl with myopia of -9.75 diopters (D) OD and -10.75 D OS and with an axial length of 26.53 mm OD and 26.36 mm OS. The patient was previously submitted to a medial rectus recess OU of 5.5 mm with no improvement of the deviation. Preoperative ET was of 25 PD for far and 18 PD for near. Three months after surgery, ET was 12 PD for far and near. The second patient is a 12-year-old girl with myopia of -8.50 D OD and -7.00 D OS and with an axial length of 26.51mm OD and 25.97 mm OS. The patient had no previous surgeries. Preoperative ET was of 40 PD for far and near. Along with the technique here described, the patient was also submitted to a hangback recess of the medial rectus OU of 5 mm. This patient is still in the early postoperative period and deviation has not yet been measured.
Conclusion: This novel surgical technique may be a new treatment option for ET associated with high myopia and no vertical deviation.