RCOphth Annual Congress 2026

Background:
High myopia may cause large-angle acquired esotropia due to superotemporal globe prolapse
This results in inferior and nasal displacement of the lateral rectus, producing severe diplopia and loss of binocular vision
Conventional recess–resect strabismus surgery is often unsuccessful as it does not correct anatomical displacement
Yokoyama loop myopexy restores the physiological muscle paths by uniting the superior rectus (SR) & lateral rectus (LR)

Aim:
To report early UK experience of Yokoyama loop myopexy combined with medial rectus recession in a patient with high myopic strabismus

Case presentation:
80-year-old male
Ocular history: High myope, pigmentary glaucoma, vitreomacular traction, macular retinoschisis
Symptoms: Persistent horizontal diplopia and large-angle esotropia
Measurements: Up to 45Δ esotropia (base out) uncorrected
Decision: listed for surgery after informed consent

Surgical technique:
Under general anaesthesia, a right medial rectus recession (4mm, non-fixed hang-back with an adjustable suture) was performed alongside a bilateral Yokoyama loop myopexy

Technical considerations:

Accessing the 15mm point along the superior rectus can be challenging

Adequate exposure and careful muscle handling are essential

Bilateral application is important to minimise postoperative hypertropia induced by unilateral surgery

Key learning points:

Treat anatomical displacement, not just deviation

Combine myopexy with MR recession

Expect early overcorrection

Consider bilateral surgery to avoid hypertropia

Conclusions:

Yokoyama loop myopexy effectively corrected severe esotropia in hight myopia by addressing the underlying mechanical displacement of the lateral rectus. When combined with medial rectus recession, this approach provided stable alignment and symptomatic relief, even in the presence of complex ocular comorbidities

RCOphth Annual Congress 2026

Early experiences of the Yokoyama Loop Myopexy in the United Kingdom

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