Surachatkumtonekul T.Jaruniphakul P.Mahidol University2026-03-152026-03-152026-03-01Siriraj Medical Journal Vol.78 No.3 (2026) , 175-184https://repository.li.mahidol.ac.th/handle/123456789/115685Objective: To determine the prevalence and predictive factors of strabismus in patients with high myopia and to evaluate the surgical outcomes of strabismus correction in this population. Materials and Methods: This retrospective cohort study included 991 patients with high myopia (1,880 eyes) who attended Siriraj Hospital between January 2021 and June 2023. High myopia was defined as a spherical equivalent (SE) ≤ -5.0 diopters or an axial length (AL) ≥ 26.5 mm. Collected data included demographics, visual acuity, refractive error, axial length, strabismus type, and surgical outcomes. Surgical success was defined as postoperative alignment within 8 prism diopters (PD) at the 8-week follow-up. ROC curve analysis was performed to determine optimal AL cut-off values for predicting strabismus. Results: Strabismus was identified in 6.7% (66/991) of patients. The mean SE and AL were -11.41 ± 4.87 D and 28.35 ± 2.06 mm, respectively. Patients with strabismus were younger and had longer AL compared to those without strabismus (p < 0.01). ROC analysis showed optimal AL thresholds of 27.5 mm for patients ≤18 years and 29.0 mm for patients >18 years, demonstrating high sensitivity, specificity, and predictive accuracy (AUC = 0.90 and 0.80, respectively). Surgical intervention was performed in 25 patients (37.9%), achieving a success rate of 76%. Conclusions: Strabismus is more prevalent in individuals with high myopia than in the general population. Axial length is a strong predictor, and defined cut-offs can guide early detection. Surgical outcomes are favorable and comparable to those in non-myopic patients, supporting targeted management strategies in this population.MedicineArticleSCOPUS10.33192/smj.v78i3.2789852-s2.0-10503211058122288082