Partial Modification of the Yamada Technique in Myopic Strabismus Fixus Treatment: Case Presentation

A 41-year-old female presented with a history of gradually increasing esotropia (ET) for 23 years. The best corrected visual acuity was 20/63 in both eyes. Refraction values were -18.50 (-1.00*55) in the right eye and -13.25 (-3.00*105) in the left eye. The axial length was measured as 29.35 mm for the right eye and 28.36 mm for the left eye. The patient's ocular motility was very restricted in the left eye with values of (-4) for abduction from the midline, (3) for elevation and (-4) for elevation in adduction. The patient's left eye had 80 prism diopters (PD) ET and 16 PD hypotropia with the prism cover test. During surgery, an 8 mm recession was first performed to the left eye medial rectus (MR). The SR and LR muscles were then divided into two for 15 mm from their insertions. The temporal half of the SR muscle and the superior half of the LR muscle were sutured together with 6/0 spatulated suture 7 mm away from the limbus at the exact midpoint of the two muscles, at the 1:30 o'clock position (Yamada procedure). A posterior fixation suture was placed on the sclera 7 mm behind the combined end of the two muscles (14 mm from the limbus) with 5/0 Ethibond suture (our modification of the Yamada procedure). Post-operative 1st day, 1st month and 6th month follow-ups were performed. On the 6th month follow-up, there was a marked decrease in the restriction of the patient’s left eye movements compared to the pre-operative period and there was 20 PD ET and 8 PD hypotropia in the primary position. Left eye movements were (+4) on abduction, (-2) on elevation and (-2) on elevation at adduction. We determined that we had achieved partial success in such cases with our partial modification of the Yamada procedure.