An inverted Yokoyama procedure combined with medial rectus recession for esotropia-hypertropia associated with high myopia: a case report

Introduction: High myopia can lead to dislocation of the posterior globe and restrictive strabismus, most commonly presenting as esotropia-hypotropia. This report highlights a rare case of esotropia-hypertropia associated with an inferotemporal staphyloma. Methods: A 45-year-old male presented with long-standing esotropia and recent-onset foreign body sensation in the right eye. Examination revealed >45° esotropia and 10° hypertropia, with marked limitation in abduction and infraduction. MRI showed inferotemporal globe herniation, superior displacement of the lateral rectus, and nasal displacement of the inferior rectus. Surgical management, performed under general anesthesia, included medial rectus recession combined with an inverted Yokoyama procedure by uniting the lateral and inferior rectus muscles. Results: Postoperatively, the patient achieved orthotropia in primary gaze with improved ductions. No intraoperative or postoperative complications occurred. The patient reported both functional and cosmetic satisfaction. Discussion: While the classic Yokoyama procedure addresses esotropia-hypotropia in high myopia, this case demonstrates that its principles can be adapted for atypical anatomical variants such as esotropia-hypertropia. The inverted approach offers a safe and effective option in carefully selected cases.