Shimizu Tamami, Hikoya Akiko, Komori Miwa, Suzuki Hiroko, Hotta Yoshihiro, Sato Miho
Department of Ophthalmology, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu-shi, Shizuoka-ken, 431-3192, Japan.
Department of Ophthalmology, Saga University Hospital, 5-1-1 Nabeshima, Saga-shi, Saga-ken, 849-0937, Japan.
Am J Ophthalmol Case Rep. 2023 Jul 7;32:101892. doi: 10.1016/j.ajoc.2023.101892. eCollection 2023 Dec.
To report stereopsis after bilateral Yokoyama procedure in patients with highly myopic strabismus and good visual acuity.
Five patients aged between 34 and 81 years with best-corrected visual acuity of 20/25 or better were operated on. The preoperative strabismus angle ranged from esotropia of 35-113 prism diopters (PD) at distance and esotropia of 40-113 PD at near. One patient had left hypotropia of 4 PD and excyclotorsion of 15°, and the other had left hypotropia of 10 PD. Their axial lengths were 27.65-33.07 mm, and the posterior globe dislocation angles were between 123 and 148° on coronal magnetic resonance imaging (MRI). Limitations of abduction were between -1 and -2. All patients complained of diplopia, and none of them showed stereopsis. The Yokoyama procedure was performed on both eyes. Postoperative alternate cover testing showed from esotropia of 2 PD to exophoria of 8 PD at distance and from exotropia of 12 PD to esophoria of 10 PD at near.Three patients recovered stereopsis of 100, 50, and 140 sec, respectively. Two cases required unilateral inferior rectus muscle recessions, and their postoperative stereopsis was 25 and 50 sec.
The Yokoyama procedure is effective not only in cases of heavy eye syndrome but also in cases of myopic esotropia associated with a globe dislocation angle of 120° or with little abduction restriction. If visual acuity is good, stereopsis may be restored with improvement in eye deviation.
报告高度近视性斜视且视力良好的患者行双眼横山手术（Yokoyama procedure）后的立体视情况。
对5例年龄在34至81岁之间、最佳矫正视力为20/25或更好的患者进行了手术。术前斜视角度在远距离时为35 - 113棱镜度（PD）的内斜视，近距离时为40 - 113 PD的内斜视。1例患者有4 PD的左眼上斜视和15°的外旋转斜视，另1例有10 PD的左眼上斜视。他们的眼轴长度为27.65 - 33.07 mm，在冠状位磁共振成像（MRI）上后极部眼球脱位角度在123°至148°之间。外展受限在 - 1至 - 2之间。所有患者均有复视主诉，且均未表现出立体视。双眼均行了横山手术。术后交替遮盖试验显示，远距离时从2 PD的内斜视变为8 PD的外斜视，近距离时从12 PD的外斜视变为10 PD的内斜视。3例患者分别恢复了100、50和140秒的立体视。2例患者需要行单侧下直肌后徙术治疗，术后立体视分别为25秒和50秒。
横山手术不仅对重度眼综合征有效，而且对伴有120°眼球脱位角度或外展受限较小的近视性内斜视也有效。如果视力良好，随着眼位偏斜的改善，立体视可能会恢复。
