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Surgical treatment of myopic strabismus fixus: a graded approach

  • Veit SturmEmail author
  • Marcel N. Menke
  • Karla Chaloupka
  • Klara Landau
Oculoplastics and Orbit

Abstract

Background

Surgical treatment of myopic strabismus fixus is challenging. Options for its correction range from conventional combined recession-resection surgery to innovative surgical procedures aiming to correct the deviated muscle paths. In this report we review our experience and compare the results of various surgical options for treatment of strabismus fixus.

Methods

We report the surgical outcomes of nine adults with acquired strabismus fixus due to myopia with a follow-up of 1 year. Patients were enrolled between May 2003 and April 2007 in this retrospective study. The surgical procedure was determined depending on the angle of deviation and extent of motility impairment. A new transposition technique was performed in one patient who had an extreme variant of strabismus fixus.

Results

Combined recession-resection surgery was performed in four patients with resulting small-angle esotropia. In patients with both esotropia and hypotropia due to muscle alignment, we performed an additional upward displacement of both horizontal recti muscles combined with a myopexy of the lateral rectus muscle. The results were satisfying; in particular in one patient who had a transposition procedure a significant improvement was achieved.

Conclusions

For treatment of myopic strabismus fixus, a graded approach seems advisable. Combined recession-resection surgery yields good results for smaller deviations with mildly impaired motility, additional fixation techniques need to be applied once the horizontal muscle paths are deviated, and in extreme cases, a transposition procedure is required.

Keywords

Convergent strabismus fixus Acquired progressive esotropia High myopia Combined recession-resection surgery 

Notes

Proprietary interest statement

None

References

  1. 1.
    von Noorden GK (1996) Strabismus fixus, clinical findings and etiology. In: von Noorden GK (ed) Binocular vision and ocular motility, 5th edn. Mosby, St. Louis, pp 443–444Google Scholar
  2. 2.
    Remόn L, Palomar T, Gabas M, Dominquez M (1996) Acquired convergent strabismus fixus associated with high myopia: a case report. Binocul Vis Strabismus Q 11:41–47Google Scholar
  3. 3.
    Parks MM, Mitchell PR (1998) Duane’s clinical ophthalmology. Lippincott; Vol I, Chap. 20:9–12Google Scholar
  4. 4.
    Meyer E, Ludatscher RM (1990) Massive fibrosis of extraocular muscles related to intraocular tumor. Ophthalmologica 200:198–202PubMedCrossRefGoogle Scholar
  5. 5.
    Sharma P, Gupta NK, Arora R, Prakash P (1991) Strabismus fixus convergens secondary to amyloidosis. J Pediatr Ophthalmol Strabismus 28:236–237PubMedGoogle Scholar
  6. 6.
    Mohan K, Sharma A, Gupta R, Gupta A (1999) Treatment of strabismus fixus convergens. J Pediatr Ophthalmol Strabismus 36:94–97PubMedGoogle Scholar
  7. 7.
    Hugonnier R, Magnard P (1969) Les désequilibres oculomoteur observés en cas de myopie forte. Ann Oculiste 202:713–724Google Scholar
  8. 8.
    Bagolini B, Tamburrelli C, Dickmann A, Colosimo C (1990) Convergent strabismus fixus in high myopic patients. Doc Ophthalmol 74:309–320 doi: 10.1007/BF00145815 PubMedCrossRefGoogle Scholar
  9. 9.
    Demer JL, von Noorden GK (1989) High myopia as an unusual cause of restrictive motility. Surv Ophthalmol 33:281–284 doi: 10.1016/0039–6257(82)90154–0 PubMedCrossRefGoogle Scholar
  10. 10.
    Ruttum MS, Lloyd MA, Lewandowsky MF (1990) Echography in the diagnosis of restrictive motility caused by severe myopia. Am J Ophthalmol 109:350–351PubMedGoogle Scholar
  11. 11.
    Krzizok TH, Kaufmann H, Traupe H (1997) Elucidation of restrictive motility in high myopia by magnetic resonance imaging. Arch Ophthalmol 115:1019–1027Google Scholar
  12. 12.
    Khan AO, Al-Wadani F (2006) Extraocular muscle pathway displacement in myopic strabismus fixus. J Pediatr Ophthalmol Strabismus 43(5):320PubMedGoogle Scholar
  13. 13.
    Bagheri A, Adhami F, Repka MX (2001) Bilateral recession-resection surgery for convergent strabismus fixus associated with high myopia. Strabismus 9(4):225–230 doi: 10.1076/stra.9.4.225.693 PubMedCrossRefGoogle Scholar
  14. 14.
    Basghaw J (1966) The “heavy eye” phenomenon: a preliminary report. Br J Ophthalmol 23:73–78Google Scholar
  15. 15.
    Hayashi T, Iwashige H, Maruo T (1999) Clinical features and surgery for acquired progressive esotropia associated with severe myopia. Acta Ophthalmol Scand 77:66–71 doi: 10.1034/j.1600–0420.1999.770115.x PubMedCrossRefGoogle Scholar
  16. 16.
    Herzau V, Ioannakis K (1996) Zur Pathogenese der Konvergenz und Hypotropie bei hoher Myopie. Klin Monatsbl Augenheilkd 208:33–36PubMedGoogle Scholar
  17. 17.
    Krzizok TH, Kaufmann H, Traupe H (1997) New approach in strabismus surgery in high myopia. Br J Ophthalmol 81:617–618Google Scholar
  18. 18.
    Yamada M, Taniguchi S, Muroi T, Satofuka S, Nishina S (2002) Rectus eye muscle paths after correction of convergent strabismus fixus. Am J Ophthalmol 134(4):630–632 doi: 10.1016/S0002–9394(02)01587–8 PubMedCrossRefGoogle Scholar
  19. 19.
    Miller JM, Demer JL, Rosenbaum AL (1993) Effect of transposition surgery on rectus muscle paths by magnetic resonance imaging. Ophthalmology 100:475–487PubMedGoogle Scholar
  20. 20.
    Larsen PC, Gole GA (2004) Partial Jensen’s procedure for the treatment of myopic strabismus fixus. J AAPOS 8:393–395 doi: 10.1016/j.jaapos.2004.04.002 PubMedGoogle Scholar
  21. 21.
    Yokoyama T, Ataka S, Tabuchi H, Shiraki K, Mihi T (2002) Treatment of progressive esotropia caused by high myopia—a new surgical procedure based on its pathogenesis. In: de Faber J-T (ed) Transactions: 27th Meeting, European Strabismological Association, Florence, Italy, 2001. Swets & Zeitlinger; Lisse (Netherlands), pp 145–148Google Scholar
  22. 22.
    Wong I, Seo-Wei L, Boo-Kian K (2005) Loop myopexy for treatment of myopic strabismus fixus. J AAPOS 9:589–591 doi: 10.1016/j.jaapos.2005.09.003 PubMedCrossRefGoogle Scholar
  23. 23.
    Kolling GH (1993) Zur Genese der Schielabweichung bei hoher Myopie. Klin Monatsbl Augenheilkd 202:151Google Scholar
  24. 24.
    Demer JL, Miller JM, Poukens V, Vinters HV, Glasgow BJ (1995) Evidence for fibromuscular pulleys of the recti extraocular muscles. Invest Ophthalmol Vis Sci 36:1125–1136PubMedGoogle Scholar
  25. 25.
    Krzizok TH, Schroeder BU (1999) Measurement of recti muscle paths by magnetic resonance imaging in highly myopic and normal patients. Invest Ophthalmol Vis Sci 40:2554–2560PubMedGoogle Scholar
  26. 26.
    Yokoyama T, Tabuchi H, Ataka S, Shiraki K, Miki T, Mochizuki K (2000) The mechanism of development in progressive esotropia with high myopia. In: de Faber J-T (ed) Transactions: 26th Meeting, European Strabismological Association, Barcelona, Spain, 2000. Swets & Zeitlinger; Lisse (Netherlands), pp 218–221Google Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Veit Sturm
    • 1
    Email author
  • Marcel N. Menke
    • 1
  • Karla Chaloupka
    • 1
  • Klara Landau
    • 1
  1. 1.Department of OphthalmologyUniversity Hospital of ZurichZurichSwitzerland

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