title: Acquired restrictive strabismus and high axial myopia: diagnosis and management.
abstract: OBJECTIVE
  This paper documents the clinical, ultrasound, magnetic resonance imaging (MRI), and anatomic characteristics of 6 patients with esohypotropia and high axial myopia. The results of strabismus surgery performed on these patients are evaluated.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Six patients with esohypotropia and high axial myopia were selected from the practice of the second author (Michael Flanders).
  
  
  METHODS
  We extracted the history and data from the preoperative and postoperative ophthalmic and orthoptic examinations, recorded the surgical procedures, and tabulated the postoperative results. A- and B-scans, orbital MRI images, and photo documentation were obtained for all patients. Supramaximal recession and resection on the horizontal rectus muscles, using adjustable sutures, was performed in all patients. A surgical outcome was deemed successful if, in primary position, postoperative horizontal ocular alignment measured 15 prism diopters (PD) or less and (or) if diplopia was eliminated.
  
  
  RESULTS
  Echographic and MRI findings demonstrated an enlarged globe in all cases. Globe flattening on the orbital walls was found in 5 cases. Lateral rectus depression was visualized on MRI images in 4 cases. Surgical success was obtained in all patients. The average preoperative primary position esotropia measured 60 PD (25 to 90 PD) and the esodeviation after surgery was 7.0 PD (0 to 15 PD). Ductions were also improved.
  
  
  CONCLUSIONS
  Different surgical approaches to realignment of eyes with high myopia and esohypotropia have been attempted. In this study, supramaximal amounts of recession and resection on the rectus muscles provided satisfactory results.
authors.affiliation: Department of Ophthalmology, McGill University, Montreal, Quebec, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Louis
authors.forename: Michael
authors.initials: M
authors.lastname: Flanders
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chankowsky
authors.forename: Susan
authors.initials: S
authors.lastname: Lindley
authors.forename: Robert
authors.initials: R
authors.lastname: Polomeno
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D013285:Strabismus / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D014463:Ultrasonography; D015348:Vision, Binocular / Q000502:physiology