Abstract： A 33-year-old male presented with progressive eso-hypotropia of the right eye after scleral buckling procedure for 15 years.Visual acuity:right eye-20.00 DS→0.1;left eye-22.00 DS/-2.0 DC×100→0.2.The intraocular pressure in both eyes was Tn.Special examination of strabismus:more than 45° esodeviation in the right eye and 10° right hypodeviation.Abduction and supraduction of the right eye were completely limited.Slit-lamp examination:the right eye had a transparent supratemporal cornea with no intraocular structures visible;the left eye had highly myopic fundus changes with a normal anterior segment.Orbital CT showed that eso-hypotropia of the right eye with superior rectus(SR)displaced medially and lateral rectus(LR)displaced inferiorly,esotropia of the left eye,and binocular high axial myopia.The patient was diagnosed with heavy eye syndrome and strabismus following scleral buckling surgery.After evaluating the retinal condition of the patient,a combination of scleral buckle removal and modified Yokoyama surgery of the right eye was proposed.However,during the Yokoyama surgery,the anterior LR and the posterior SR were found to be severely adherent to the sclera.The surgical plan was adjusted to 12mm medial rectus(MR)muscle recession in the right eye in combination with superior rectus muscle transposition(SRT)associated with LR-SR muscle belly union.1.5 months after the surgery,10° esotropia remained,so strabismus surgery was performed on the left eye:5mm MR recession combined with 7mm LR resection.3 months after left eye strabismus surgery,almost orthophoria was shown with significantly improved abduction and supraduction of the right eye,and no recurrent retinal detachment was detected on fundus examination.For strabismus after scleral buckling surgery,the pros and cons of scleral buckle removal should be weighed before strabismus surgery.Once the buckle is removed,close follow-up should be performed to detect recurrent retinal detachment.When severe extraocular muscle adhesions are found during the Yokoyama procedure,the surgical plan needs to be adjusted promptly,and in this case,SRT combined with SR-LR union achieved good results.