Managing monocular elevation deficiency may depend on choosing the right surgical technique, study suggests

The proper management of monocular elevation deficiency may depend on using results from forced duction testing to choose the correct surgical technique, a retrospective study by researchers in India suggests.

Shashikant Shetty, MS, and colleagues at Aravind Eye Hospital in Madurai evaluated outcomes after performing one of four surgical procedures on 28 patients with monocular elevation deficiency between June 2003 and August 2006. For each case, the investigators chose the procedure based on forced duction test results.

Specifically, five patients underwent a Knapp procedure with or without horizontal squint surgery, 17 patients had inferior rectus recession with or without horizontal squint surgery, three patients had inferior rectus recession combined with a Knapp procedure, and three patients had inferior rectus recession combined with contralateral superior rectus or inferior oblique surgery, according to the study.

At baseline, patients averaged 14.03 years of age.

Of the 28 total patients, 23 (82%) had positive forced duction test results, and overall, 24 (86%) were aligned to within 10 prism-diopters after surgery.

Elevation had improved from no elevation above primary position to only slight limitation of elevation in 10 patients (36%); elevation had improved to –2 in seven patients, according to the study.

While five patients had binocular single vision at baseline, no patients in any of the surgical groups gained binocular single vision after surgery.

"No significant postoperative complications or duction abnormalities were observed during the follow-up period," the authors said.

The study is published in the April issue of Indian Journal of Ophthalmology.