Challenges of Managing Monocular Elevation Deficiency – A Series of 14 Patients
Chandni Chakraborty, MS
Vivekananda Mission Asram Netra Niramay Niketan
Chaitanyapur(Haldia),District: Purba Medinipur, State: West Bengal, India
Introduction: Monocular Elevation Deficiency itself presents a surgical challenge to the strabismologist. It is further complicated by the presence of associated horizontal strabismus and complex ptosis. Here a series of 14 patients with MED managed in our hospital are presented.
Methods: A series of 14 MED patients were followed prospectively. Thorough pre- operative evaluation was done for every patient. The surgical procedure, post-operative course, complications, final outcome and follow up pattern were noted.
Results: Age ranged from 6 years to 18 years.8 were female and 6 male. Right eye was involved in 8(57%) of them,12(85.71%) had amblyopia in deviated eye,10(71.43%) had associated horizontal strabismus,2 patients underwent previous strabismus surgery. Surgical planning included correction of strabismus in first stage and ptosis correction with or without surgery for residual strabismus in second stage.6(42%) patients underwent bilateral surgery in first stage. Second surgery was done in 6(42%) patients where only 3 needed additional strabismus correction. 7(50%) patients were lost for follow up. Out of the rest 7 patients 6(85.7%) achieved orthophoria.
Discussion: Delayed presentation and loss of follow up were two major challenges affecting outcome in management of MED. Proper counselling about the need for two/more stages of surgical treatment may improve patient compliance and follow up rate.
Conclusion: A precise pre-operative work up and meticulous decision making can improve surgical outcome in Monocular Elevation Deficiency immensely.
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