Effects of modified Yokoyama surgery combined with medial rectus muscle recession on esotropia in highly myopia athletes.

BACKGROUND: Fixed esotropia in high myopia, characterized by irreversible inward ocular deviation and abduction limitation, presents unique therapeutic challenges for athletes requiring precise binocular coordination. The combination of Yokoyama surgery and medial rectus muscle recession has been proposed as an advanced technique addresses both myopia-induced globe displacement and muscular imbalance offering potential advantages over conventional strabismus surgery in this population.

AIM: To investigate the effects of the modified Yokoyama surgery coupled with medial rectus muscle recession in restoring ocular motility and correcting esotropia among athletes with high myopia and fixed esotropia.

METHODS: A retrospective study analyzed 30 highly myopia athletes (57 eyes) with fixed esotropia treated at our hospital from January 2022 to April 2024. The participants were allocated into two groups based on the surgical method: The traditional group (n = 15, 29 eyes) received conventional strabismus surgery, and the combined group (n = 15, 28 eyes) underwent modified Yokoyama surgery in combination with medial rectus muscle recession. Eye movement improvement, esotropia alleviation, and complications were compared preoperatively and at 1, 3, and 6 months post-treatment.

RESULTS: Both surgical groups exhibited similar baseline scores (traditional: -4.04 ± 0.38 vs combined: -4.12 ± 0.45, P > 0.05), showing severe preoperative limitations in ocular motility. Following the intervention, the combined group achieved significantly better outcomes at both 1 month (combined: -2.25 ± 0.28 vs traditional: -2.67 ± 0.32) and 3 months (combined: -1.48 ± 0.28 vs traditional: -1.76 ± 0.43), with statistically significant improvements (P < 0.05). However, by 6 months, no significant difference was observed between the two groups (combined: -0.93 ± 0.13; traditional: -1.03 ± 0.18; P > 0.05). Prior to treatment, all patients in both groups exhibited a compensatory head posture (CHP). Following treatment, the incidence of CHP decreased to 6.67% in the combined group and 20.00% in the traditional group, both reductions being significant compared to pre-treatment levels (P < 0.05). Nevertheless, the difference in CHP incidence between the two groups after treatment was not significant (P > 0.05). The rates of improvement in esotropia showed an increasing trend in both groups at 1 month (46.43% vs 34.48%), 3 months (78.57% vs 51.728%), and 6 months (100.00% vs 89.66%) post-treatment. Notably, the combined group had a significantly higher improvement rate than the traditional group at the 3-month follow-up (P < 0.05). No significant difference was observed in the esotropia improvement rates between the two groups at 1 and 6 months post-treatment (P > 0.05). The combined group experienced slightly lower but not significant (combined group: 0.00% vs traditional: 3.45%) as opposed to the traditional group (3.45%; P > 0.05).

CONCLUSION: The combination of modified Yokoyama surgery and medial rectus muscle recession provides effective and safe approach to improving in eye movement and esotropia in athletes with high myopia and fixed esotropia, offering reliable clinical benefits.