Poster 189

by in  Poster Session 3

Single Muscle Transposition in Monocular Elevation Deficit (MED) – A Novel Surgical Technique

Uppal V. Gandhi, DNB; Ramesh Kekunnaya, MD
L.V. Prasad Eye Institute
Hyderabad, Telangana, India


Introduction: The purpose of this study is to put forth a novel surgical technique for the treatment of MED and report its short-term outcomes.

Methods: This is a prospective interventional case series consisting patients with MED. Single horizontal rectus muscle is transposed to 2 mm from the insertion of the superior rectus (SR) along the spiral of tillaux, augmenting it with the Fosters suture taken 8 mm behind its insertion.

Results: Five patients with MED were included. Mean age was 12.4 years. 4 patients underwent lateral rectus (LR) and one underwent medial rectus (MR) transposition respectively. Intraoperatively IR was tight in all subjects. Mean follow up period was 2 months. Mean hypotropia reduced from 34.6 prism diopters (PD range:20-48) preoperatively to 2PD (range:0-8) postoperatively at 2 months. Additionally horizontal deviation was seen in all patients, 3 of which had exotropia with mean of 12PD (2-20) and 2 had esotropia with mean of 28.5PD (12-40); one underwent LR recession and one MR recession. All underwent inferior rectus(IR) recession. Mean elevation deficit in abduction, straight upgaze, adduction improved from 4.6, 3.2, 2.4 to 1.8, 2, 2 respectively. Mean depression deficit was 0.5, no limitation of adduction and abduction were noted. No adverse effects were noted.

Discussion: This modification allows sparing of atleast one horizontal muscle to tackle accompanying horizontal deviation. It achieves adequate elevation effect with no torsional changes and overcorrections atleast in the short term follow up.

Conclusion: Single muscle transposition with IR recession is a promising primary surgical option in MED with good surgical outcome.|

References: 1. Bandyopadhyay R, Shetty S, Vijayalakshmi P. Surgical outcome in monocular elevation deficit: A retrospective interventional study. Ind J Ophthalmol 2008; 56:127-33
2. Burke JP, Ruben JB, Scott WE. Vertical transposition of the horizontal recti for the treatment of double elevator palsy: Effectiveness and long-term stability. Br J Ophthalmol 1992 76:734-7.
3. Tibrewal S, Sachdeva V, Ali MH, Kekunnaya R. Comparison of augmented superior rectus transposition with medial rectus recession for surgical management of esotropic Duane retraction syndrome. J AAPOS. 2015 Jun;19(3):199-205

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